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Wisconsin rates for HCPCS K0005

Ultralightweight Wheelchair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.05 / $1,721.05 / $1,721.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.81 / $1,548.94 / $2,035.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,582.80 / $4,700.70 / $4,700.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,402.00 / $2,402.28 / $3,486.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.81 / $1,393.66 / $5,527.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,460.50 / $1,460.50 / $6,942.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,460.50 / $2,994.75 / $3,743.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.15 / $1,848.76 / $3,097.89
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.01 / $1,479.01 / $3,099.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.15 / $3,099.72 / $12,056.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,012.76 / $1,447.47 / $2,877.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.16 / $55.00 / $2,583.10
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.15 / $2,040.00 / $3,097.89
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.01 / $1,479.01 / $3,099.72
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.93 / $516.66 / $670.85
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,460.50 / $5,045.12 / $12,056.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,460.50 / $1,460.50 / $1,916.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,583.10 / $2,583.10 / $2,583.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,583.10 / $2,583.10 / $2,583.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.82 / $1,288.68 / $2,583.10