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Wisconsin rates for HCPCS 90964

End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 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
$557.58 / $1,920.99 / $1,920.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.74 / $523.37 / $666.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.29 / $667.11 / $1,685.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,358.89 / $1,587.97 / $2,435.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.72 / $1,165.57 / $1,723.10
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473.94 / $559.39 / $940.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.48 / $560.24 / $1,040.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.57 / $796.06 / $3,786.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.59 / $515.63 / $1,087.29
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.98 / $557.58 / $940.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.05 / $1,190.89 / $1,698.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.85 / $1,039.54 / $2,337.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.38 / $2,336.00 / $3,786.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.99 / $919.81 / $1,813.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.36 / $735.82 / $1,561.90