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Utah rates for HCPCS 90947

Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated evaluations by a physician or other qualified health care professional, with or without substantial revision of dialysis prescription

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.99 / $145.99 / $145.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.22 / $122.28 / $168.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.01 / $158.90 / $227.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.43 / $126.41 / $152.66
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.79 / $183.57 / $239.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.20 / $133.38 / $201.78