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Utah rates for HCPCS 64625

Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

Facilitymedian $4,169 · 10th–90th $692–$7,9430%10%10th90th$4,169Professionalmedian $479 · 10th–90th $191–$1,1750%10%10th90th$479$50.0$200.0$1.0K$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
$691.83 / $4,168.69 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $478.63 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $537.03 / $812.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $2,041.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $3,801.89 / $5,888.44
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$4,168.69 / $5,754.40 / $8,709.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $537.03 / $1,096.48
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $478.63 / $1,148.15
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $676.08 / $1,071.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,466.84 / $7,079.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $467.74 / $977.24