go back

Wisconsin 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
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,537.00 / $5,305.45 / $5,305.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $9,240.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $5,133.39 / $9,240.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.27 / $260.27 / $260.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $55.00 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,133.39 / $5,133.39 / $9,240.12
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $80.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.27 / $260.27 / $260.27