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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
$19.98 / $19.98 / $19.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.30 / $19.98 / $21.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.59 / $28.99 / $32.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.13 / $24.25 / $32.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.81 / $24.30 / $42.11
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $21.05 / $38.86
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 / $34.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.66 / $15.99 / $24.98