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Montana 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
Professional
Modifier
Low / Median / High Price
$380.55 / $472.98 / $724.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$811.31 / $811.31 / $811.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.96 / $628.80 / $1,252.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.48 / $612.88 / $1,026.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.66 / $960.00 / $1,380.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.40 / $766.08 / $905.84