go back

Utah rates for HCPCS 64492

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $3,311.31 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $97.72 / $346.74
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$128.82 / $162.18 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $102.33 / $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
$97.72 / $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 / $190.55
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
$56.23 / $89.13 / $141.25