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South Dakota rates for HCPCS E1222

Wheelchair With Fixed Arm Elevating Legrests (Special Coverage Instructions Apply. See Cim: 60-6)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.29 / $874.26 / $874.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$779.66 / $779.66 / $779.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.75 / $1,068.75 / $1,335.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.69 / $1,118.67 / $4,248.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.67 / $641.33 / $713.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.61 / $104.16 / $104.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.62 / $108.25 / $205.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.56 / $464.84 / $892.77