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Wisconsin 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
$22.31 / $22.31 / $22.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.48 / $19.47 / $25.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.10 / $60.24 / $60.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $30.78 / $44.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.33 / $23.31 / $76.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.72 / $20.72 / $84.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $36.75 / $45.94
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $28.56 / $41.06
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.44 / $20.44 / $42.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $41.06 / $148.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.86 / $17.82 / $40.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.19 / $50.00 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $28.56 / $41.06
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.44 / $20.44 / $42.84
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $7.10 / $9.22
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.61 / $64.20 / $148.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $20.72 / $27.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.13 / $35.13 / $35.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.13 / $35.13 / $35.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.83 / $17.48 / $38.19