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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
$645.65 / $2,238.72 / $2,238.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,862.09 / $2,951.21
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $645.65 / $1,071.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $645.65 / $1,230.27
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,445.44 / $2,089.30
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $3,801.89