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Montana 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,275.38 / $13,275.38 / $13,275.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,527.46 / $13,275.38 / $14,357.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,526.41 / $14,383.53 / $17,324.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,527.46 / $13,275.38 / $14,357.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,522.22 / $6,109.84 / $6,994.04