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Indiana 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
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $5,133.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $6,850.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,770.67 / $5,305.45 / $7,484.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$837.08 / $1,422.49 / $12,036.35
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.12 / $1,329.48 / $11,817.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,003.19 / $7,003.19 / $7,003.19