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Indiana 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
Facility
Modifier
Low / Median / High Price
$13,489.63 / $13,489.63 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,918.31 / $12,302.69 / $14,125.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,481.54 / $15,848.93 / $24,547.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $20,417.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $13,182.57 / $13,182.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $13,182.57 / $25,118.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $2,187.76 / $9,549.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $6,918.31 / $10,715.19