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Indiana rates for HCPCS K0195

Elevating Leg Rests Pair (For Use With Capped Rental Wheelchair Base) (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.35 / $98.35 / $98.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.64 / $80.59 / $105.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.45 / $104.45 / $178.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.26 / $19.29 / $149.18
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.93 / $16.50 / $171.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $88.70 / $98.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.52 / $75.40 / $137.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.74 / $9.91 / $121.65