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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
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,982.44 / $16,982.44 / $16,982.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $13,182.57 / $13,182.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $13,182.57 / $14,454.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $14,454.40 / $17,378.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $13,182.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,445.44 / $9,549.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $6,165.95 / $6,918.31