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Georgia 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 / $5,133.39 / $5,133.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,244.35 / $5,305.45 / $5,305.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$539.86 / $539.86 / $5,398.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,500.00 / $15,500.00 / $15,500.00