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Pennsylvania 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
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $15.85 / $34.67
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $17.38 / $28.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $26.92 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $19.05 / $33.11
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $23.99 / $34.67
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $18.62 / $29.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $18.20 / $45.71
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $16.60 / $33.88
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $26.30 / $33.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $16.60 / $17.78
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $17.78 / $64.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $16.22 / $27.54