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South Dakota rates for HCPCS E1200

Amputee wheelchair, fixed full-length arms, swing-away detachable footrest

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.04 / $955.55 / $955.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.73 / $746.73 / $1,001.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,196.25 / $1,208.21 / $1,495.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.57 / $1,721.97 / $5,455.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.65 / $823.29 / $915.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.67 / $113.85 / $123.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.31 / $138.51 / $264.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.37 / $596.96 / $1,315.93