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South Carolina 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
$16.20 / $17.82 / $22.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $25.22 / $39.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.55 / $21.16 / $22.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $27.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.46 / $19.48 / $41.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.73 / $28.73 / $28.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.19 / $11.98 / $21.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.24 / $15.99 / $23.26