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Illinois 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
$10.45 / $18.44 / $28.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.43 / $2.43 / $2.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $35.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $37.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $3.24 / $4.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.65 / $4.86 / $26.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.76 / $17.23 / $29.15