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Maine 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
$4,770.67 / $5,247.73 / $5,612.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,740.00 / $16,740.00 / $16,740.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,740.00 / $16,740.00 / $16,740.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $5,133.39