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Montana rates for HCPCS E2390

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

Insurance Carrier
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.31 / $5.31 / $5.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $32.79 / $53.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.79 / $44.93 / $53.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.03 / $51.54 / $71.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.79 / $44.93 / $53.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $24.82 / $41.36