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Montana rates for HCPCS E2221

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.12 / $70.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.39 / $3.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $24.55 / $36.31
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $26.92 / $38.02
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $26.92 / $38.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $28.84 / $42.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $36.31 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $13.49 / $22.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $15.14 / $17.78