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Utah rates for HCPCS 64605

Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $3,388.44 / $7,079.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $645.65 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $660.69 / $1,258.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $812.83
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
$602.56 / $1,047.13 / $1,819.70
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $1,000.00 / $1,584.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,230.27 / $1,862.09
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
$316.23 / $537.03 / $954.99