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Utah rates for HCPCS 64645

Chemodenervation of one extremity; each additional extremity, 5 or more muscles (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $3,019.95 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $123.03 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $131.83 / $223.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $177.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $208.93 / $316.23
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $147.91 / $234.42
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $177.83 / $263.03
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
$75.86 / $109.65 / $165.96