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Ohio 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
$17.30 / $17.30 / $17.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.92 / $17.30 / $31.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.38 / $40.49 / $64.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.13 / $23.26 / $51.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $23.21 / $32.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $21.42 / $40.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $37.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $37.50
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $22.73
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.16 / $21.16 / $21.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.40 / $24.60 / $34.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.66 / $15.99 / $23.26