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Texas 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
$28.42 / $36.15 / $48.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $4.32 / $4.32
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.87 / $56.87 / $78.20
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 / $51.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $280.00 / $280.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.82 / $48.03 / $78.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.20 / $52.32 / $71.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.82 / $39.29 / $78.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.15 / $39.01 / $50.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.56 / $37.29 / $57.37
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.99 / $47.32 / $47.32