go back

Monthly Kidney Disease Management, Adult Patient

North Carolina 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?

$324

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $324 for this service. The price depends on where it is billed: about $324 from a physician practice, and about $324 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 8 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$324$275 to $447
FacilityA hospital or hospital-owned outpatient department$324$288 to $407

How much rates vary

Facilitymedian $324 · 10th to 90th $251 to $513Professionalmedian $324 · 10th to 90th $234 to $646
$5.0$20.0$100.0$500.0$2.0Kfacility $324professional $324

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$288.40
Typical High
$549.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$281.84
Typical High
$331.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$380.19
Typical High
$660.69
Cigna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$346.74
Typical High
$630.96
Medcost
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Medcost
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$323.59
Typical High
$512.86
Medcost
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$588.84
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$269.15
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$263.03
Typical High
$489.78
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$1,862.09
Typical High
$1,862.09
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,905.46
Median
$1,905.46
Typical High
$2,398.83

Where North Carolina sits

The same service costs 2.1 times more in Minnesota than in Vermont. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

North Carolina $324 · 12th of 51
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.