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Indiana rates for HCPCS E2390

Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.02 / $31.02 / $31.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.78 / $31.02 / $32.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.63 / $44.89 / $50.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.17 / $37.93 / $50.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.38 / $37.61 / $65.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.26 / $32.84 / $60.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $32.79 / $32.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.87 / $32.79 / $53.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $24.82 / $38.57