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Pennsylvania rates for HCPCS E2386

Power Wheelchair Accessory Foam Filled Drive Wheel Tire Any Size Replacement Only Each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.29 / $68.67 / $91.17
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.59 / $113.32 / $113.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.17 / $81.17 / $114.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.98 / $81.17 / $180.47
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.25 / $104.25 / $113.32
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.31 / $107.99 / $107.99
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.29 / $67.86 / $98.43
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.17 / $81.17 / $114.51
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.98 / $81.17 / $180.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.24 / $123.24 / $131.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.16 / $85.54 / $158.04