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South Dakota rates for HCPCS E2392

Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $39.81 / $48.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $33.11 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $66.07 / $75.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $69.18 / $239.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $29.51 / $57.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $66.07 / $66.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $36.31 / $58.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70