go back

Utah rates for HCPCS 64493

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $3,019.95 / $5,754.40
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,089.30 / $2,238.72 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $194.98 / $630.96
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$83.18 / $295.12 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $177.83 / $288.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $177.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,584.89 / $3,630.78
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,041.74 / $2,398.83 / $5,370.32
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $269.15 / $457.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $199.53 / $371.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $257.04 / $346.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,818.38 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $151.36 / $269.15