go back

South Dakota rates for HCPCS E2612

General use wheelchair back cushion, width 22 in or greater, any height, including any type mounting hardware

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.46 / $309.23 / $372.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.36 / $326.36 / $498.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.88 / $498.87 / $538.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.45 / $847.29 / $1,749.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.72 / $311.92 / $440.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.53 / $49.89 / $49.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.53 / $94.19 / $516.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.00 / $275.51 / $440.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.17 / $408.17 / $408.17