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South Dakota rates for HCPCS E2376

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.52 / $1,410.38 / $1,410.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.26 / $642.26 / $1,519.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.00 / $1,772.55 / $2,193.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,281.60 / $2,922.26 / $8,276.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.00 / $1,260.40 / $1,474.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.80 / $172.10 / $172.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.80 / $324.62 / $1,780.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.44 / $921.48 / $1,437.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,408.05 / $1,408.05 / $1,408.05