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Wisconsin rates for HCPCS K0891

Power Wheelchair Group 5 Pediatric Multiple Power Option Sling/Solid Seat/Back Patient Weight Capacity Up To And Including 125 Pounds

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.66 / $13,531.66 / $13,531.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,748.77 / $13,531.66 / $13,531.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,425.72 / $6,638.55 / $6,638.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,619.91 / $11,619.91 / $11,619.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,876.92 / $9,876.92 / $11,619.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,962.53 / $13,531.66 / $24,356.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $13,531.66 / $24,356.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.03 / $792.03 / $792.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $55.00 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,962.53 / $13,531.66 / $24,356.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $80.00 / $11,619.91
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,876.92 / $11,619.91 / $11,619.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.03 / $792.03 / $792.03