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Utah 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
$25.12 / $44.67 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $38.90 / $67.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $44.67 / $57.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $63.10 / $74.13
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $7.59 / $63.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $22.91 / $40.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $31.62 / $57.54