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Montana rates for HCPCS K0855

Power wheelchair, group 3 extra heavy-duty, captain's chair, patient weight capacity 601 pounds or more

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,102.62 / $10,102.62 / $10,102.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,162.40 / $10,102.62 / $10,926.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,771.69 / $10,420.65 / $13,184.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,162.40 / $10,102.62 / $10,926.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,202.46 / $4,649.60 / $7,749.33