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South Dakota rates for HCPCS E2375

Power wheelchair accessory, nonexpandable controller, including all related electronics and mounting hardware, replacement only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.63 / $790.74 / $790.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.96 / $407.96 / $542.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.08 / $933.75 / $1,167.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.12 / $1,785.47 / $2,957.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.94 / $603.05 / $910.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.37 / $105.14 / $105.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.37 / $198.47 / $1,087.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.49 / $568.88 / $713.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.22 / $860.22 / $860.22