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South Dakota rates for HCPCS E2204

Manual Wheelchair Accessory Nonstandard Seat Frame Depth 22 To 25 Inches

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.45 / $713.59 / $876.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.12 / $763.12 / $1,151.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.38 / $1,151.33 / $1,297.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.64 / $1,955.24 / $4,173.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.70 / $727.69 / $931.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.30 / $115.14 / $115.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.30 / $217.34 / $1,191.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.30 / $470.11 / $931.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.00 / $942.00 / $942.00