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Wisconsin rates for HCPCS E2381

Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.68 / $53.68 / $53.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.89 / $45.33 / $59.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.59 / $141.22 / $141.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.17 / $72.18 / $104.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.62 / $49.49 / $166.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.02 / $48.02 / $189.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.02 / $82.13 / $102.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $73.38 / $105.49
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.94 / $60.94 / $110.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $110.08 / $344.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.54 / $51.11 / $94.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.01 / $50.00 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.14 / $73.38 / $105.49
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.94 / $60.94 / $110.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.24 / $15.78 / $20.48
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.02 / $150.69 / $344.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.02 / $48.02 / $56.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.54 / $85.54 / $85.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.54 / $85.54 / $85.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.60 / $49.49 / $85.54