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New Hampshire 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
$26.59 / $33.15 / $34.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.16 / $54.16 / $54.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.32 / $47.32 / $51.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.01 / $39.01 / $39.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.15 / $39.01 / $47.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.28 / $121.49 / $153.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $30.09 / $53.99
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.97 / $58.70 / $74.70