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Wisconsin rates for HCPCS 64490

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level

Facilitymedian $2,455 · 10th–90th $251$4,4670%10%20%10th90th$2,455Professionalmedian $275 · 10th–90th $107$1,6980%10%10th90th$275$0.2$2.0$20.0$200.0$2.0K

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
$134.90 / $1,071.52 / $2,884.03
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$912.01 / $2,818.38 / $3,548.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $223.87 / $741.31
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$229.09 / $588.84 / $3,235.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $239.88 / $537.03
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$229.09 / $354.81 / $812.83
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $128.82 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $602.56 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $416.87 / $870.96
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $229.09 / $3,311.31
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $346.74 / $537.03
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$295.12 / $512.86 / $794.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $269.15 / $3,630.78
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$977.24 / $2,630.27 / $2,818.38
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $407.38 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$338.84 / $338.84 / $338.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $147.91
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $2,951.21 / $3,235.94
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $354.81 / $630.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $331.13 / $676.08
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $1,819.70 / $2,691.53
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $741.31 / $3,467.37
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $676.08
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $676.08 / $1,148.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,754.23 / $5,011.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $257.04 / $691.83