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Montana rates for HCPCS E2389

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

Insurance Carrier
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.42 / $3.42 / $3.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $34.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.16 / $28.73 / $34.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.89 / $32.95 / $45.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.16 / $28.73 / $34.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.65 / $15.99 / $18.44