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Virginia 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
$30.17 / $30.17 / $30.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.52 / $30.17 / $38.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.16 / $50.16 / $50.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.93 / $37.93 / $37.93
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 / $43.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.59 / $42.64 / $55.92
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.37 / $27.32 / $51.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.93 / $44.93 / $44.93
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $28.15 / $49.91
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $20.79 / $44.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.58 / $25.11 / $41.07