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North Dakota 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
$15,723.84 / $15,723.84 / $15,723.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,959.54 / $12,959.54 / $15,723.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,682.72 / $28,884.44 / $29,383.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,053.75 / $25,304.29 / $31,818.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,526.41 / $14,509.39 / $24,033.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,740.00 / $7,529.15 / $11,480.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.23 / $7,128.15 / $11,480.00