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Michigan rates for HCPCS K0857

Power wheelchair, group 3 standard, single power option, captain's chair, patient weight capacity up to and including 300 pounds

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,958.32 / $7,958.32 / $7,958.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,613.58 / $7,958.32 / $8,327.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,095.79 / $39,526.44 / $52,701.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$801.95 / $8,230.56 / $14,815.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.88 / $679.35 / $9,171.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.12 / $836.12 / $8,361.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,818.66 / $3,818.66 / $3,818.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.67 / $3,818.66 / $12,116.25
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $5,224.56 / $15,677.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.96 / $826.32 / $7,512.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,313.46 / $3,272.04 / $5,186.39