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Utah rates for HCPCS 64625

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $4,168.69 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $467.74 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $407.38 / $870.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,041.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,388.44 / $7,585.78
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,365.16 / $5,128.61 / $11,481.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $537.03 / $1,122.02
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $467.74 / $1,148.15
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $691.83 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $467.74 / $831.76