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Montana rates for HCPCS 90967

End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients younger than 2 years of age

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $16.98 / $24.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.34 / $27.34 / $27.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.09 / $23.66 / $47.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.57 / $21.72 / $35.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.75 / $35.88 / $47.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $29.59 / $35.71