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Utah rates for HCPCS 64420

Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$812.83 / $812.83 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $123.03 / $281.84
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$91.20 / $338.84 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $114.82 / $204.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $208.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,230.27 / $2,754.23
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,584.89 / $1,862.09 / $4,073.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $165.96 / $302.00
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $138.04 / $346.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $144.54 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,818.38 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $95.50 / $169.82