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Utah rates for HCPCS 64495

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; 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
$123.03 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$239.88 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $89.13 / $309.03
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $173.78 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $89.13 / $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
$58.88 / $100.00 / $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
$46.77 / $81.28 / $131.83