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South Dakota rates for HCPCS E2222

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $19.05 / $25.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $17.38 / $33.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $32.36 / $37.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $33.88 / $123.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $13.49 / $25.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $31.62 / $32.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $33.11 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $16.22 / $28.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $26.30 / $26.30