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Illinois rates for HCPCS K0864

Power Wheelchair Group 3 Extra Heavy Duty Multiple Power Option Sling/Solid Seat/Back Patient Weight Capacity 601 Pounds Or More

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,994.04 / $12,342.42 / $17,031.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,275.38 / $13,275.38 / $13,275.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,603.83 / $13,275.38 / $25,053.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $200.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$972.54 / $3,241.80 / $9,903.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,062.03 / $6,963.76 / $12,741.63