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Utah 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
$10.00 / $25.12 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $22.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $22.91 / $41.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $25.70 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $36.31 / $36.31
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $4.37 / $36.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $11.22 / $24.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.69 / $16.22 / $31.62