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Indiana rates for HCPCS E2386

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.72 / $85.72 / $85.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.57 / $67.04 / $92.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.18 / $112.37 / $125.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.50 / $133.43 / $169.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.56 / $103.59 / $192.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.78 / $98.88 / $183.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.17 / $81.17 / $81.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.98 / $81.17 / $171.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $68.64 / $127.93