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Minnesota rates for HCPCS K0864

Power wheelchair, group 3 extra heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,959.54 / $12,959.54 / $12,959.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,534.77 / $12,959.54 / $15,723.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,569.20 / $17,289.59 / $24,221.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,865.14 / $21,081.43 / $22,692.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,275.38 / $13,275.38 / $54,292.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,053.75 / $25,304.29 / $31,818.26
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,405.26 / $38,405.26 / $42,749.87
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,053.75 / $25,053.75 / $25,053.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,135.84 / $14,408.01 / $21,612.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.23 / $6,835.59 / $14,468.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.23 / $6,822.66 / $14,468.33