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Utah rates for HCPCS 64415

Injection Aa&/Strd Brachial Plexus W/Img Gdn

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.83 / $2,633.98 / $3,977.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,011.10 / $1,011.10 / $1,011.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.98 / $114.18 / $333.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.63 / $125.56 / $209.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.71 / $122.33 / $144.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,361.81 / $1,728.22 / $2,518.51
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,042.72 / $2,592.33 / $3,777.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.02 / $193.80 / $311.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,106.00 / $1,649.00 / $2,824.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.82 / $128.80 / $202.86