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Montana rates for HCPCS 90969

End-stage renal disease (ESRD) related services for dialysis less than a full month of service, per day; for patients 12-19 years of age

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $16.98 / $29.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $26.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $20.42 / $50.12
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $28.18 / $30.90
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $28.18 / $30.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $22.91 / $37.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $36.31 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $24.55 / $28.84