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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
$16.05 / $16.05 / $16.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.87 / $16.05 / $20.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.76 / $15.76 / $15.76
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.72 / $17.35 / $27.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.16 / $19.16 / $19.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $18.92 / $32.31
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.44 / $36.44 / $36.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $22.84 / $34.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.37 / $16.66 / $30.72
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $16.60 / $16.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $24.97 / $34.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.16 / $19.16 / $19.16
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.08 / $18.92 / $31.55
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.54 / $16.54 / $16.54
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.12 / $16.54 / $17.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $16.23 / $26.08