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Utah rates for HCPCS 64400

Injection Aa&/Strd Trigeminal Nerve Each Branch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.87 / $525.84 / $3,977.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.42 / $113.88 / $256.82
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$144.80 / $830.88 / $927.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.72 / $122.84 / $187.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.45 / $89.98 / $110.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.21 / $561.58 / $818.38
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$648.32 / $842.37 / $1,227.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.79 / $189.30 / $336.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.00 / $4,445.00 / $4,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.55 / $115.90 / $180.51