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Utah 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
Professional
Modifier
Low / Median / High Price
$5,495.41 / $7,943.28 / $10,471.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,079.46 / $7,079.46 / $7,079.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,025.60 / $7,079.46 / $7,244.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $60.26