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Ohio 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
$6,850.00 / $6,850.00 / $6,850.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $6,850.00 / $6,850.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,305.45 / $7,484.00 / $11,978.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.62 / $886.32 / $8,256.78
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.35 / $837.08 / $6,668.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.85 / $588.08 / $4,704.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.73 / $183.73 / $183.73