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South Dakota rates for HCPCS E2617

Custom fabricated wheelchair back cushion, any size, including any type mounting hardware

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.05 / $336.05 / $3,694.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.10 / $413.10 / $413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.00 / $757.50 / $937.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.50 / $6,244.40 / $10,124.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.28 / $948.28 / $948.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,072.23 / $1,072.23 / $1,072.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.28 / $948.28 / $948.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.74 / $713.74 / $713.74