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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $3,019.95 / $5,754.40
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,122.02 / $1,122.02 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $114.82 / $407.38
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$89.13 / $144.54 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $100.00 / $169.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $117.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $162.18 / $257.04
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $109.65 / $204.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $141.25 / $194.98
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
$54.95 / $89.13 / $141.25