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Washington rates for HCPCS 64491

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)

Facilitymedian $186 · 10th–90th $78$6,4570%10%10th90th$186Professionalmedian $126 · 10th–90th $60$4470%10%10th90th$126$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$109.65 / $524.81 / $9,772.37
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$977.24 / $1,258.93 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $109.65 / $512.86
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$87.10 / $190.55 / $549.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $97.72 / $154.88
Ambetter
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$144.54 / $144.54 / $173.78
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $537.03
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$794.33 / $794.33 / $794.33
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $141.25 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $707.95 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $128.82 / $257.04
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $125.89 / $229.09
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $125.89 / $229.09
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $56.23
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $181.97 / $194.98
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $134.90
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $134.90 / $239.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $537.03
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$630.96 / $630.96 / $794.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $141.25 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $549.54 / $5,754.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $123.03 / $218.78
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $102.33 / $147.91