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Utah 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
$19.95 / $38.02 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $33.11 / $33.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $33.11 / $60.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $32.36 / $46.77
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $50.12 / $61.66
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $6.03 / $50.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.57 / $19.50 / $36.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $25.70 / $45.71