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Minnesota 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
$5,133.39 / $5,133.39 / $5,133.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $5,133.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,202.83 / $4,202.83 / $24,739.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,362.26 / $4,202.83 / $4,202.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $6,850.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.75 / $815.75 / $815.75