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Virginia 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
$5,133.39 / $5,133.39 / $5,133.39
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
$5,305.45 / $5,305.45 / $5,305.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,003.37 / $5,003.37 / $5,003.37
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $5,800.74
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.70 / $548.70 / $548.70
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.70 / $548.70 / $548.70