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South Dakota rates for HCPCS K0004

High Strength Lightweight Wheelchair

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.49 / $785.80 / $829.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.44 / $455.44 / $654.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $654.00 / $750.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.74 / $2,243.51 / $2,522.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.78 / $662.97 / $880.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.03 / $133.72 / $133.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.03 / $253.95 / $1,386.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.68 / $550.13 / $880.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.13 / $1,094.13 / $1,094.13