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Hawaii rates for HCPCS E2389

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

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.18 / $26.18 / $26.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.16 / $25.46 / $36.04
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.77 / $34.31 / $42.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.87 / $29.40 / $45.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.97 / $14.97 / $36.04
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.90 / $27.00 / $28.42