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Montana rates for HCPCS E0995

Wheelchair accessory, calf rest/pad, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $158.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $21.88 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $25.70 / $36.31
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $28.18 / $39.81
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $28.18 / $39.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $30.20 / $51.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $36.31 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $13.18 / $24.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $18.20