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Michigan rates for HCPCS K0877

Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $6,918.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $3,890.45 / $38,018.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,762.47 / $10,471.29 / $10,471.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $7,079.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $5,128.61 / $5,128.61
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $5,623.41