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South Dakota rates for HCPCS E1240

Lightweight Wheelchair Detachable Arms (Desk Or Full Length) Swing Away Detachable Elevating Legrest (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.20 / $1,329.09 / $1,329.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.00 / $200.00 / $1,185.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,493.75 / $1,590.00 / $1,987.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.71 / $1,585.85 / $6,458.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.37 / $974.74 / $1,084.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.66 / $158.35 / $158.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.88 / $302.58 / $1,645.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.86 / $974.74 / $1,180.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,295.55 / $1,295.55 / $1,295.55