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Utah rates for HCPCS 64490

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level

Facilitymedian $2,818 · 10th–90th $794$5,4950%10%10th90th$2,818Professionalmedian $234 · 10th–90th $110$7940%5%10%10th90th$234$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$933.25 / $2,951.21 / $5,495.41
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$794.33 / $2,630.27 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $208.93 / $630.96
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$162.18 / $275.42 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $181.97 / $323.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $223.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,737.80 / $2,691.53
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,905.46 / $2,630.27 / $3,981.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $302.00 / $501.19
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $218.78 / $416.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $269.15 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $2,818.38 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $169.82 / $316.23