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Power Wheelchair, Group 4 Standard, Single Power Option

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

Rates data updated October 2026.

How much does Power Wheelchair, Group 4 Standard, Single Power Option cost?

$5,623

Typical negotiated rate. In Minnesota, October 2026.

Insurers have agreed to pay about $5,623 for this service. The price depends on where it is billed: about $4,169 from a physician practice, and about $6,918 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$4,169$4,169 to $5,754
FacilityA hospital or hospital-owned outpatient department$6,918$5,129 to $16,596

How much rates vary

Facilitymedian $6,918 · 10th to 90th $4,169 to $22,387Professionalmedian $4,169 · 10th to 90th $3,388 to $7,079
$500$1K$2K$5K$10K$20K$50Kfacility $6,918professional $4,169

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$6,918.31
Median
$6,918.31
Typical High
$6,918.31
Aetna
Setting
Professional
Modifier
None
Typical Low
$6,918.31
Median
$6,918.31
Typical High
$6,918.31
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$3,981.07
Median
$4,168.69
Typical High
$23,442.29
BCBS Minnesota
Setting
Professional
Modifier
None
Typical Low
$2,754.23
Median
$4,168.69
Typical High
$4,168.69
BCBS Minnesota
Setting
Professional
Modifier
RR · Rental
Typical Low
$338.84
Median
$416.87
Typical High
$416.87
Cigna
Setting
Facility
Modifier
None
Typical Low
$11,748.98
Median
$17,782.79
Typical High
$50,118.72
Cigna
Setting
Professional
Modifier
None
Typical Low
$5,623.41
Median
$5,888.44
Typical High
$7,079.46
Health Partners
Setting
Facility
Modifier
None
Typical Low
$10,715.19
Median
$16,982.44
Typical High
$39,810.72
Health Partners
Setting
Professional
Modifier
None
Typical Low
$4,466.84
Median
$5,623.41
Typical High
$5,623.41
Medica
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$5,128.61
Typical High
$8,709.64
2 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Facility
Modifier
UE · Used equipment
Typical Low
$5,128.61
Median
$5,128.61
Typical High
$5,128.61
Aetna
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$5,128.61
Median
$5,128.61
Typical High
$5,128.61

Where Minnesota sits

The same service costs 234422.9 times more in South Dakota than in Louisiana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Minnesota· 10th of 50

$5,623

SD $7,079LA $0.03

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.