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South Dakota rates for HCPCS E2633

Wheelchair accessory, addition to mobile arm support, supinator

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.73 / $157.91 / $157.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.53 / $70.53 / $211.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.38 / $211.18 / $236.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.94 / $195.58 / $802.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.45 / $134.88 / $150.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.57 / $21.12 / $21.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.57 / $35.61 / $218.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.40 / $93.77 / $150.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.78 / $172.78 / $172.78