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South Dakota rates for HCPCS E2390

Power Wheelchair Accessory Solid (Rubber/Plastic)Drive Wheel Tire Any Size Replacement Only Each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.65 / $46.29 / $46.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $32.79 / $55.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.13 / $58.71 / $72.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.86 / $94.94 / $235.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.53 / $41.06 / $47.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.55 / $5.59 / $5.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.55 / $10.53 / $57.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.48 / $41.06 / $57.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.76 / $45.76 / $45.76