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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
$13,371.00 / $13,371.00 / $13,371.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,608.03 / $13,370.96 / $14,193.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,364.40 / $15,910.41 / $19,888.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,512.84 / $2,809.56 / $20,328.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,404.78 / $2,593.44 / $22,793.93
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
$1,191.07 / $13,275.38 / $13,275.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.23 / $6,888.00 / $9,845.81