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Wisconsin 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
$14,399.49 / $14,399.49 / $14,399.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,093.03 / $12,959.54 / $17,031.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,612.00 / $39,333.83 / $39,333.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,910.41 / $20,099.16 / $26,582.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,554.77 / $1,554.77 / $4,624.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,568.60 / $13,275.38 / $58,086.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,284.07 / $25,053.75 / $31,317.19
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,135.84 / $14,399.49 / $21,599.24
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.16 / $957.16 / $17,289.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $14,408.01 / $21,599.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,178.32 / $7,188.04 / $16,047.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $14,070.33
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,135.84 / $14,399.49 / $21,599.24
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.16 / $957.16 / $17,289.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,427.13 / $4,321.84 / $5,611.59
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $7,568.60 / $14,509.39
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,527.46 / $13,275.38 / $13,275.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,783.92 / $7,188.04 / $15,274.61