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Wisconsin rates for HCPCS 90967

End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.93 / $64.88 / $64.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.94 / $18.27 / $24.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.52 / $22.65 / $59.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.96 / $53.70 / $82.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.66 / $40.56 / $58.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.18 / $19.16 / $34.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.18 / $19.42 / $35.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.41 / $30.81 / $162.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.43 / $63.63 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.14 / $19.18 / $34.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.22 / $40.65 / $57.20
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.97 / $35.11 / $105.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.98 / $88.30 / $162.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.47 / $34.70 / $61.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.82 / $27.37 / $59.89