go back

South Dakota rates for HCPCS E2221

Manual Wheelchair Accessory Solid (Rubber/Plastic) Caster Tire (Removable) Any Size Replacement Only Each. (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.74 / $29.85 / $29.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.20 / $27.20 / $38.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.75 / $38.31 / $45.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $40.11 / $148.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.86 / $25.46 / $31.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $3.82 / $3.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.78 / $7.20 / $39.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.54 / $25.46 / $41.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.35 / $31.35 / $31.35