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Washington 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
$155.69 / $211.86 / $336.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.22 / $130.57 / $274.91
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.38 / $115.38 / $115.38
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $1,564.67 / $1,564.67
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.33 / $250.14 / $1,165.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.56 / $200.44 / $361.79
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.08 / $200.67 / $292.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.67 / $187.96 / $292.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.38 / $214.82 / $381.04
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.88 / $234.50 / $242.54
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.28 / $271.25 / $339.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.71 / $237.98 / $308.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.76 / $185.50 / $339.85
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.21 / $126.80 / $126.80