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South Dakota rates for HCPCS K0855

Power wheelchair, group 3 extra heavy-duty, captain's chair, patient weight capacity 601 pounds or more

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $12,022.64 / $15,135.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,054.61 / $19,054.61 / $23,988.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $19,054.61 / $30,902.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $5,128.61 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $5,128.61 / $10,964.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,791.08 / $14,791.08 / $14,791.08