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Utah rates for HCPCS 64630

Dstrj Neurolytic Agent Pudendal Nerve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.62 / $3,038.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.53 / $266.62 / $992.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.44 / $289.42 / $474.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.94 / $195.01 / $260.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,361.81 / $1,728.22 / $2,518.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.70 / $474.17 / $625.90
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
$206.91 / $256.77 / $407.96