go back

Utah rates for HCPCS 90964

End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.97 / $540.97 / $540.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.00 / $500.96 / $724.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.02 / $634.64 / $968.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.82 / $485.22 / $605.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.87 / $739.07 / $914.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.60 / $509.97 / $802.41