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South Dakota rates for HCPCS K0864

Power wheelchair, group 3 extra heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,773.85 / $19,953.58 / $19,953.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,275.38 / $13,275.38 / $13,275.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,053.75 / $25,304.29 / $31,317.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,423.82 / $14,509.39 / $40,480.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,740.00 / $10,183.07 / $11,980.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,976.71 / $1,976.71 / $4,543.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,462.40 / $4,699.57 / $24,705.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,783.92 / $7,188.04 / $11,980.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,450.80 / $19,450.80 / $19,450.80