go back

South Dakota rates for HCPCS K0877

Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $6,918.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,754.40 / $7,079.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,481.54 / $11,748.98 / $18,620.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $501.19