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Montana rates for HCPCS E2220

Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $147.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $3.24 / $3.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $27.54 / $35.48
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $26.30 / $41.69
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $26.30 / $41.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $27.54 / $40.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $35.48 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $13.49 / $24.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $16.22 / $18.62