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Utah rates for HCPCS 64612

Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $3,162.28 / $6,025.60
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$363.08 / $363.08 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $218.78 / $741.31
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$169.82 / $501.19 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $181.97 / $288.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $245.47
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $512.86 / $1,148.15
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$645.65 / $758.58 / $1,737.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $257.04 / $363.08
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $213.80 / $316.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $204.17 / $302.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $141.25 / $218.78