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Utah rates for HCPCS 64494

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $3,019.95 / $5,888.44
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$575.44 / $660.69 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $107.15 / $537.03
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$72.44 / $147.91 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $87.10 / $151.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $102.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $147.91 / $234.42
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $102.33 / $190.55
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $131.83 / $177.83
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
$45.71 / $79.43 / $128.82