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Indiana rates for HCPCS E2221

Manual Wheelchair Accessory Solid (Rubber/Plastic) Caster Tire (Removable) Any Size Replacement Only Each. (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.72 / $20.72 / $20.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $20.72 / $21.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.12 / $29.59 / $33.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.72 / $25.41 / $33.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.19 / $24.80 / $42.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $22.76 / $39.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.72 / $20.72 / $27.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.61 / $20.72 / $36.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.18 / $16.57 / $25.55