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South Dakota rates for HCPCS E2628

Wheelchair Accessory Shoulder Elbow Mobile Arm Support Attached To Wheelchair Balanced Reclining

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.16 / $859.90 / $859.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.39 / $369.39 / $1,127.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.63 / $1,127.95 / $1,308.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.44 / $1,024.41 / $4,343.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.01 / $706.53 / $785.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.25 / $112.79 / $112.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.25 / $186.39 / $1,166.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.64 / $491.13 / $785.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$922.87 / $922.87 / $922.87