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Indiana rates for HCPCS E2389

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $18.20 / $19.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $33.11 / $41.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.99 / $37.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $37.15 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $21.38 / $21.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $21.38 / $36.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $13.80 / $24.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $16.98 / $25.12