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Utah rates for HCPCS 64484

Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Facilitymedian $2,951 · 10th–90th $240–$5,1290%10%10th90th$2,951Professionalmedian $123 · 10th–90th $51–$4790%5%10th90th$123$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $3,019.95 / $5,754.40
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$691.83 / $691.83 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $128.82 / $537.03
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$69.18 / $117.49 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $93.33 / $186.21
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $81.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $158.49 / $234.42
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $165.96 / $295.12
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $151.36 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $89.13 / $162.18