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South Dakota rates for HCPCS K0857

Power wheelchair, group 3 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,144.55 / $9,649.45 / $9,649.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,818.66 / $3,818.66 / $3,818.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,116.25 / $12,237.41 / $15,145.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,524.53 / $7,016.64 / $19,576.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,775.84 / $4,924.47 / $5,793.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$955.92 / $955.92 / $2,196.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.81 / $2,272.67 / $11,947.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,201.92 / $3,476.08 / $6,967.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,406.35 / $9,406.35 / $9,406.35