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Pennsylvania 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
$2,649.57 / $5,491.02 / $6,863.78
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $6,270.90 / $6,967.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,818.66 / $3,818.66 / $3,818.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,245.86 / $3,818.66 / $12,116.25
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,974.35 / $6,974.35 / $6,974.35
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,466.73 / $5,765.57 / $7,958.32
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,818.66 / $3,818.66 / $3,818.66
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.60 / $3,818.66 / $15,145.31
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,380.98 / $9,947.90 / $9,947.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,317.39 / $3,476.08 / $6,283.56