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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)

Facilitymedian $3,388 · 10th–90th $123–$5,7540%10%10th90th$3,388Professionalmedian $107 · 10th–90th $51–$4170%5%10%10th90th$107$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
$123.03 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$239.88 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $91.20 / $309.03
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$120.23 / $302.00 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $89.13 / $151.36
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $102.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $144.54 / $229.09
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $109.65 / $190.55
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $190.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $81.28 / $131.83
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98