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Arizona rates for HCPCS K0877

Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $6,850.00 / $6,850.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.94 / $153.94 / $192.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,002.03 / $4,002.70 / $6,654.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $6,850.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $5,133.39