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South Dakota rates for HCPCS E0954

Wheelchair Accessory Foot Box Any Type Includes Attachment And Mounting Hardware Each Foot (Reinstated Code) Old Description: Semi-Pneumatic Caster Each (Not Valid For Medicare) (Deleted 12/31/05)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.54 / $47.85 / $61.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.15 / $56.64 / $77.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.63 / $77.20 / $93.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.86 / $80.87 / $309.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.64 / $53.21 / $60.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.60 / $7.80 / $7.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.60 / $13.34 / $79.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.62 / $33.17 / $60.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.17 / $63.17 / $63.17