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South Dakota rates for HCPCS E2627

Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable Rancho type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.63 / $1,104.98 / $1,104.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.66 / $542.66 / $1,475.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.88 / $1,475.08 / $1,659.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$986.86 / $1,359.82 / $5,719.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.93 / $935.28 / $1,043.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.13 / $147.53 / $147.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.13 / $247.48 / $1,525.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.86 / $935.28 / $1,511.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.88 / $1,206.88 / $1,206.88