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Monthly Kidney Disease Management, Adult Patient

Pennsylvania 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.

Facilitymedian $288 · 10th–90th $275$5250%20%40%10th90th$288Professionalmedian $302 · 10th–90th $209$5010%10%20%10th90th$302$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$302.00
Typical High
$501.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$302.00
Typical High
$398.11
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$302.00
Typical High
$389.05
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$302.00
Typical High
$457.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$524.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$302.00
Typical High
$537.03
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$436.52
Typical High
$616.60
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$331.13
Typical High
$524.81
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$354.81
Typical High
$398.11
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$302.00
Typical High
$346.74
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$302.00
Typical High
$501.19
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$269.15
Typical High
$524.81
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$288.40
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$269.15
Typical High
$478.63