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Alaska rates for HCPCS E2389

Power wheelchair accessory, foam caster tire, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.04 / $34.04 / $34.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $21.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $21.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.93 / $18.55 / $27.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $24.69 / $32.67
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.19 / $27.36 / $40.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.22 / $18.89 / $26.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $21.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.14 / $30.94 / $54.69