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Montana rates for HCPCS E0954

Wheelchair Accessory Foot Box Any Type Includes Attachment And Mounting Hardware Each Foot (Reinstated Code) Old Description: Semi-Pneumatic Caster Each (Not Valid For Medicare) (Deleted 12/31/05)

Insurance Carrier
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.04 / $7.04 / $7.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.15 / $43.15 / $69.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.15 / $69.64 / $69.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.15 / $53.96 / $69.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.15 / $50.66 / $69.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.93 / $31.93 / $53.21