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Pennsylvania 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 / $31.58 / $42.02
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.38 / $53.77 / $53.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.01 / $39.01 / $51.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.15 / $39.01 / $84.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.47 / $49.47 / $53.77
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.42 / $48.42 / $48.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.59 / $31.58 / $45.23
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.01 / $39.01 / $51.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.15 / $39.01 / $84.38
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.35 / $57.35 / $63.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.85 / $38.93 / $72.67