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North Carolina 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
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,159.12 / $10,159.12 / $10,159.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $6,160.08
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $100.00