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Maine rates for HCPCS E2387

Power wheelchair accessory, foam filled caster tire, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.85 / $43.12 / $43.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.63 / $62.41 / $115.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.12 / $46.20 / $47.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.01 / $39.01 / $63.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.15 / $39.01 / $50.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.28 / $43.28 / $43.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.85 / $34.17 / $43.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.99 / $49.11 / $110.23