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Montana rates for HCPCS E2392

Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $93.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.31 / $6.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $33.11 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $44.67 / $63.10
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $50.12 / $60.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $60.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $63.10 / $91.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $63.10 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.57 / $22.39 / $36.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $31.62