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South Dakota rates for HCPCS E2369

Power wheelchair component, drive wheel gear box, replacement only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.72 / $435.34 / $435.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.93 / $332.93 / $342.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.00 / $530.25 / $656.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.20 / $977.41 / $1,865.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.81 / $320.49 / $483.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.13 / $57.56 / $57.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.13 / $108.60 / $595.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.25 / $320.49 / $475.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.97 / $470.97 / $470.97