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Nebraska 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
$26.74 / $26.74 / $26.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.50 / $24.50 / $24.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.68 / $29.87 / $31.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $35.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.16 / $35.94 / $46.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.89 / $32.95 / $151.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.99 / $15.99 / $29.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.58 / $3.60 / $6.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $4.43 / $8.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $15.99 / $29.15