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New Hampshire 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
Professional
Modifier
Low / Median / High Price
$15.01 / $17.41 / $17.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.45 / $32.45 / $32.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.32 / $25.32 / $25.32
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 / $24.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.92 / $72.76 / $92.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.90 / $16.35 / $20.44
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.61 / $29.49 / $37.53