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South Dakota rates for HCPCS K0814

Power wheelchair, group 1 standard, portable, captain's chair, patient weight capacity up to and including 300 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,123.96 / $3,643.61 / $3,643.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,416.31 / $2,416.31 / $2,416.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,982.50 / $4,022.33 / $4,978.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$343.59 / $3,744.63 / $8,559.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.70 / $1,915.40 / $2,735.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.46 / $503.83 / $503.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.46 / $952.74 / $5,216.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.13 / $1,303.72 / $2,405.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,122.27 / $4,122.27 / $4,122.27