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Maine rates for HCPCS E2390

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.03 / $30.13 / $30.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.75 / $57.80 / $107.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.92 / $32.90 / $37.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $32.79 / $48.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.87 / $32.79 / $39.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.08 / $40.08 / $40.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.37 / $17.03 / $30.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $38.43 / $74.73