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Maine 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
$12,938.47 / $12,938.47 / $14,383.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,364.40 / $13,791.74 / $15,910.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,275.38 / $13,275.38 / $14,056.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,527.46 / $13,275.38 / $13,275.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,623.63 / $17,623.63 / $17,623.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,086.28 / $12,938.47 / $14,383.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,792.03 / $7,061.35 / $16,530.29