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South Dakota rates for HCPCS E2201

Manual Wheelchair Accessory Nonstandard Seat Frame Width Greater Than Or Equal To 20 Inches And Less Than 24 Inches

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.99 / $314.51 / $375.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.88 / $325.88 / $507.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.25 / $507.38 / $539.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.24 / $861.76 / $1,745.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.88 / $304.45 / $411.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.38 / $50.73 / $50.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.38 / $95.83 / $525.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.62 / $304.45 / $372.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.13 / $415.13 / $415.13