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Utah rates for HCPCS 61640

Balloon Dilat Intracranial Vasospasm Prq Initial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.70 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.29 / $891.70 / $1,185.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.43 / $808.13 / $892.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.06 / $383.71 / $560.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.60 / $666.89 / $854.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.46 / $1,445.19 / $1,844.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,292.00 / $4,455.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.33 / $560.40 / $1,008.73