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Wisconsin rates for HCPCS 90963

End-stage renal disease (ESRD) related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.24 / $2,240.51 / $2,240.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,585.07 / $1,852.28 / $2,841.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.70 / $650.24 / $1,095.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$556.75 / $650.24 / $1,223.97
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.77 / $643.92 / $1,095.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.85 / $1,389.11 / $1,981.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.08 / $1,212.44 / $2,726.38