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North Carolina 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
$8,135.84 / $15,139.44 / $15,139.44
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 / $31,317.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,135.84 / $15,139.44 / $17,031.87
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,562.70 / $12,562.70 / $12,562.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,792.03 / $7,064.54 / $11,477.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $14,509.39 / $14,509.39