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South Dakota rates for HCPCS E2221

Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $22.91 / $28.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $26.92 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $38.02 / $46.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $40.74 / $147.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $16.22 / $30.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $38.02 / $38.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $19.50 / $34.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62