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Virginia 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
$19.48 / $19.48 / $19.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.78 / $19.48 / $24.59
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
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $21.53 / $22.02
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 / $27.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.87 / $27.53 / $35.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.47 / $17.60 / $32.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.73 / $28.73 / $28.73
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $18.19 / $31.91
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $13.39 / $28.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.19 / $16.14 / $26.47