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South Dakota rates for HCPCS K0890

Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,874.59 / $7,874.59 / $10,569.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,100.47 / $7,100.47 / $7,100.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,100.47 / $7,100.47 / $7,100.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,861.61 / $17,861.61 / $28,959.06