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South Dakota rates for HCPCS E2387

Power wheelchair accessory, foam filled caster tire, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.59 / $48.06 / $57.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.01 / $39.01 / $77.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.50 / $77.53 / $84.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.96 / $131.68 / $280.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.95 / $49.11 / $68.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.69 / $7.74 / $7.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.69 / $14.62 / $80.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.88 / $32.38 / $67.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43