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Utah rates for HCPCS 61791

Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,230.27 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,479.11 / $2,454.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,235.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,388.44 / $7,585.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,570.40 / $3,311.31
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,691.53 / $3,467.37
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,995.26 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,288.25 / $2,344.23