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South Dakota rates for HCPCS K0858

Power wheelchair, group 3 heavy-duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,690.15 / $11,736.90 / $11,736.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,978.93 / $4,978.93 / $4,978.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,737.50 / $14,884.88 / $18,421.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,719.58 / $8,534.45 / $23,811.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,376.34 / $5,989.80 / $7,046.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,162.72 / $1,162.72 / $2,672.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,448.43 / $2,764.33 / $14,531.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,813.95 / $4,228.08 / $7,046.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,441.16 / $11,441.16 / $11,441.16