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Virginia 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
$18.84 / $18.84 / $18.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.54 / $18.84 / $25.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.32 / $31.32 / $31.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.32 / $25.32 / $25.32
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.93 / $19.93 / $20.78
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 / $27.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.94 / $25.99 / $36.39
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $17.23 / $35.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.83 / $26.83 / $26.83
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $3.68 / $27.59
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.68 / $27.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.83 / $17.09 / $25.55