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Texas 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
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $80.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $7,633.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $5,133.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $7,633.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $16,740.00 / $16,740.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,305.45 / $5,305.45 / $5,612.55