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Wisconsin 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
$33.40 / $33.40 / $33.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $30.06 / $39.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.10 / $91.18 / $91.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.59 / $46.65 / $67.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.71 / $27.79 / $107.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $32.79 / $152.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.79 / $58.13 / $72.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.37 / $41.23 / $60.12
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $34.22 / $61.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.37 / $80.00 / $235.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.49 / $29.30 / $62.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.28 / $38.79 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.37 / $50.10 / $60.12
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $34.22 / $61.85
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $11.83 / $15.36
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $97.38 / $235.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.79 / $32.79 / $39.42
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.84 / $50.84 / $50.84
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.84 / $50.84 / $50.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.53 / $28.50 / $50.84