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Wisconsin rates for HCPCS E2215

Manual wheelchair accessory, tube for pneumatic caster tire, any size, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.94 / $8.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $23.44 / $23.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $12.88 / $17.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $51.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $15.49 / $24.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $8.71 / $15.49
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $7.76 / $7.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $13.49 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $6.76 / $12.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $50.12 / $89.13
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $3.09 / $4.27
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $25.12 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $7.94 / $9.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $5.13 / $8.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $6.61 / $13.80