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Utah 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
$17.39 / $17.39 / $17.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.32 / $16.70 / $23.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $20.66 / $31.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.79 / $26.00 / $76.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $23.38 / $28.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.31 / $16.77 / $25.52