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Pennsylvania 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
$17.09 / $26.27 / $32.84
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $36.29 / $50.16
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 / $72.66
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.15 / $46.15 / $50.16
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.11 / $35.11 / $35.11
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.09 / $26.27 / $35.02
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $32.79 / $32.79
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.87 / $32.79 / $72.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.84 / $47.72 / $47.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.10 / $26.96 / $50.84