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South 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
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,400.00 / $5,500.00 / $6,934.05
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $6,365.42
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $5,133.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,610.32 / $3,491.16