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Monthly Kidney Disease Management, Adult Patient

Illinois rates for HCPCS 90961

This covers a month of ongoing outpatient management for an adult with end-stage kidney disease, including a defined number of in-person check-ins with the treating clinician during that month along with related care coordination. It reflects one of several tiers of this monthly service that differ by how many in-person visits occurred.

Rates data updated July 2026.

How much does Monthly Kidney Disease Management, Adult Patient cost?

$331

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $331 for this service. The price depends on where it is billed: about $331 from a physician practice, and about $372 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$331$275 to $372
FacilityA hospital or hospital-owned outpatient department$372$372 to $741

How much rates vary

Facilitymedian $372 · 10th to 90th $372 to $1,023Professionalmedian $331 · 10th to 90th $224 to $525
$100$200$500$1Kfacility $372professional $331

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$302.00
Typical High
$512.86
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$295.12
Typical High
$398.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$1,023.29
Typical High
$1,348.96
BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$331.13
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$363.08
Typical High
$575.44
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$562.34
Typical High
$776.25
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$363.08
Typical High
$389.05
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$323.59
Typical High
$660.69

Where Illinois sits

The same service costs 2.1 times more in Minnesota than in Vermont. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Illinois· 9th of 51

$331

MN $501VT $240

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.