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Wisconsin rates for HCPCS 90957

Esrd Related Svc Monthly 12-19 Yr Old 4/> Visits

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$824.28 / $2,845.54 / $2,845.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.84 / $767.28 / $1,076.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.85 / $951.27 / $2,491.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,006.79 / $2,345.10 / $3,597.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.62 / $1,724.42 / $2,549.27
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.60 / $820.12 / $1,452.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$670.80 / $820.12 / $1,525.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.98 / $1,096.58 / $5,409.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.02 / $706.86 / $1,484.63
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$665.60 / $811.52 / $1,497.69
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,201.30 / $1,763.96 / $2,515.69
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$876.11 / $1,539.85 / $3,462.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.22 / $3,275.19 / $5,409.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.88 / $1,244.04 / $2,680.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.97 / $1,076.41 / $2,329.48