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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
$25.82 / $25.82 / $174.89
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 / $67.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.42 / $40.14 / $58.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.82 / $36.10 / $57.37