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Indiana rates for HCPCS K0891

Power wheelchair, group 5 pediatric, multiple 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
$13,531.70 / $13,531.70 / $13,531.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,531.66 / $13,531.66 / $16,247.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,638.55 / $6,638.55 / $8,927.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,087.50 / $7,087.50 / $7,087.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,619.91 / $11,619.91 / $11,619.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,762.89 / $9,876.92 / $11,619.91