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South Dakota rates for HCPCS E2389

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.78 / $22.27 / $29.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $35.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $37.88 / $46.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.12 / $61.02 / $151.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.13 / $26.26 / $30.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.58 / $3.60 / $3.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.58 / $6.79 / $37.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.13 / $26.26 / $37.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.40 / $29.40 / $29.40