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Montana rates for HCPCS E2216

Manual wheelchair accessory, foam filled propulsion tire, any size, each

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.06 / $36.06 / $65.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.06 / $65.92 / $65.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.06 / $52.86 / $66.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.06 / $45.08 / $65.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $17.36 / $23.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.75 / $25.75 / $42.92