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Utah rates for HCPCS 64636

Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.63 / $2,683.85 / $5,844.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$891.04 / $3,697.35 / $5,546.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.34 / $242.44 / $1,027.11
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$81.45 / $194.16 / $663.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.69 / $175.83 / $380.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.06 / $205.27 / $258.90
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.31 / $182.53 / $442.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.97 / $194.80 / $301.39