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Utah rates for HCPCS 64491

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)

Facilitymedian $2,951 · 10th–90th $490–$5,4950%10%10th90th$2,951Professionalmedian $126 · 10th–90th $60–$4900%5%10%10th90th$126$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
$302.00 / $3,019.95 / $5,754.40
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $120.23 / $549.54
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$87.10 / $144.54 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $100.00 / $162.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $117.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $158.49 / $251.19
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $125.89 / $204.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $138.04 / $194.98
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
$54.95 / $89.13 / $147.91