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Michigan rates for HCPCS K0890

Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,874.59 / $7,874.59 / $7,874.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,197.07 / $7,874.59 / $10,569.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,101.58 / $14,065.13 / $18,753.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.36 / $2,928.77 / $5,271.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,381.18 / $6,381.18 / $6,381.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,100.47 / $7,100.47 / $7,100.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,100.47 / $7,100.47 / $7,100.47
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.81 / $272.39 / $7,874.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $50.00