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Utah rates for HCPCS G0454

Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.94 / $10.94 / $10.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.96 / $8.36 / $10.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $7.74 / $7.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.92 / $16.30 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.96 / $11.65 / $14.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.80 / $10.66 / $15.68