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Maine rates for HCPCS K0857

Power wheelchair, group 3 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,256.94 / $6,256.94 / $6,622.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,129.43 / $6,669.51 / $6,669.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,818.66 / $3,818.66 / $6,797.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.67 / $3,818.66 / $4,604.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,522.65 / $8,522.65 / $8,522.65
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,394.04 / $6,256.94 / $6,622.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,317.39 / $3,476.08 / $9,647.87