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Utah 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
$10.47 / $10.47 / $92.48
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 / $37.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.99 / $19.39 / $30.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.64 / $15.99 / $23.26