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Montana rates for HCPCS E2387

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

Insurance Carrier
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $7.40 / $7.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.01 / $39.01 / $74.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.01 / $67.03 / $74.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.86 / $74.00 / $107.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.01 / $67.03 / $74.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.47 / $29.47 / $49.11