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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

Facilitymedian $3,020 · 10th–90th $977$5,7540%10%10th90th$3,020Professionalmedian $229 · 10th–90th $81$8130%5%10th90th$229$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
$245.47 / $3,019.95 / $5,754.40
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$2,089.30 / $2,238.72 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $204.17 / $676.08
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $295.12 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $162.18 / $288.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $177.83
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
$144.54 / $269.15 / $457.09
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $199.53 / $371.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $245.47 / $363.08
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
$81.28 / $151.36 / $288.40
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$363.08 / $363.08 / $380.19