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Wisconsin rates for HCPCS E2388

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.78 / $38.78 / $38.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.37 / $34.90 / $45.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $105.56 / $105.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.89 / $53.94 / $78.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $32.74 / $124.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.90 / $37.90 / $176.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.90 / $67.13 / $83.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.27 / $48.53 / $69.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.31 / $40.31 / $72.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.27 / $90.03 / $272.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.31 / $34.51 / $72.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.18 / $40.31 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.27 / $58.17 / $69.80
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.31 / $40.31 / $72.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.66 / $14.20 / $18.44
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.90 / $112.54 / $272.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.90 / $37.90 / $45.55
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.31 / $59.31 / $59.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.31 / $59.31 / $59.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.51 / $33.61 / $72.05