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Maine 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
$10.89 / $19.37 / $19.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.48 / $37.32 / $69.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.14 / $21.05 / $24.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $31.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $25.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.88 / $25.88 / $25.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $10.89 / $19.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.66 / $18.73 / $48.00