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South Dakota rates for HCPCS E2394

Power Wheelchair Accessory Drive Wheel Excludes Tire Any Size Replacement Only Each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.24 / $57.37 / $68.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.18 / $46.18 / $92.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.25 / $92.54 / $100.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.28 / $157.19 / $331.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.83 / $59.85 / $81.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.19 / $9.26 / $9.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.19 / $17.50 / $95.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.82 / $51.02 / $81.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.72 / $75.72 / $75.72