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New Hampshire rates for HCPCS K0858

Power wheelchair, group 3 heavy-duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,344.64 / $7,012.85 / $7,012.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,239.16 / $6,239.16 / $6,239.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,978.93 / $4,978.93 / $4,978.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.47 / $4,978.93 / $4,978.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,366.40 / $29,099.52 / $36,882.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,706.85 / $4,190.35 / $5,540.96
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,657.45 / $7,376.30 / $9,388.02