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Wisconsin 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 $1,318 · 10th–90th $76$3,6310%10%10th90th$1,318Professionalmedian $148 · 10th–90th $60$5750%10%10th90th$148$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
$54.95 / $1,698.24 / $6,606.93
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $3,467.37
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $125.89 / $478.63
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$91.20 / $331.13 / $1,862.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,584.89 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $128.82 / $288.40
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$128.82 / $190.55 / $436.52
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $72.44 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $302.00 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $229.09 / $446.68
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $123.03 / $3,311.31
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $173.78 / $269.15
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$162.18 / $263.03 / $407.38
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $134.90 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$977.24 / $977.24 / $1,202.26
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $194.98 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $186.21 / $309.03
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $177.83 / $338.84
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $371.54
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $371.54 / $2,754.23
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $346.74
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $338.84 / $575.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,584.89 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $128.82 / $346.74