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South Dakota rates for HCPCS E1172

Amputee Wheelchair Detachable Arms (Desk Or Full Length) Without Footrests Or Legrest (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.48 / $1,093.29 / $1,093.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.94 / $840.94 / $1,127.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.08 / $1,586.25 / $1,982.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.37 / $2,017.76 / $6,143.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.51 / $927.01 / $1,030.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.31 / $130.26 / $130.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.63 / $155.97 / $297.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.16 / $671.99 / $1,030.99