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New Hampshire 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
$10.78 / $17.77 / $17.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.39 / $32.39 / $32.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.25 / $24.25 / $24.25
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 / $25.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.88 / $72.65 / $92.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.66 / $15.99 / $25.88
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.16 / $27.87 / $35.47