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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
$436.52 / $549.54 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $630.96 / $1,380.38
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $870.96 / $954.99
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $870.96 / $954.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $707.95 / $1,202.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $812.83 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $758.58 / $891.25