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Utah rates for HCPCS 61640

Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $478.63 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $891.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,905.46
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $602.56 / $891.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,698.24 / $1,905.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $1,122.02 / $1,548.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $831.76 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $630.96 / $1,000.00