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Pennsylvania 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 / $16.92 / $21.15
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $24.59 / $32.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $22.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $46.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.80 / $29.80 / $32.39
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.64 / $19.64 / $24.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.78 / $16.92 / $22.56
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $22.73
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $46.88
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.56 / $30.74 / $30.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.42 / $17.48 / $32.67