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Utah 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 / $8,135.84 / $8,135.84
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
$1,527.46 / $13,275.38 / $25,053.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,890.96 / $8,624.92 / $13,673.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,212.49 / $6,109.84 / $11,583.30