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Ohio rates for HCPCS 64493

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $1,513.56 / $4,677.35
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$676.08 / $2,818.38 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $177.83 / $426.58
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$169.82 / $316.23 / $977.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $162.18 / $323.59
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$125.89 / $213.80 / $380.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $2,238.72 / $3,981.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $109.65 / $177.83
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$120.23 / $165.96 / $269.15
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $95.50 / $158.49
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $109.65 / $144.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $218.78 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $173.78 / $295.12
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $851.14 / $1,778.28
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $162.18 / $295.12
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$128.82 / $128.82 / $549.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $50.12
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $1,096.48
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $186.21 / $281.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,862.09 / $4,073.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $147.91 / $295.12