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Wisconsin 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

Facilitymedian $2,818 · 10th–90th $794$5,7540%10%10th90th$2,818Professionalmedian $269 · 10th–90th $89$1,2300%5%10th90th$269$50.0$200.0$1.0K$5.0K

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
$281.84 / $1,905.46 / $4,365.16
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$870.96 / $2,818.38 / $6,165.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $194.98 / $676.08
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$138.04 / $478.63 / $2,511.89
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
$131.83 / $204.17 / $457.09
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$199.53 / $309.03 / $676.08
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $109.65 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $562.34 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $363.08 / $812.83
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $204.17 / $3,311.31
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $302.00 / $489.78
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$251.19 / $457.09 / $741.31
DeanCare
Facility/Professional
Professional
Modifier
80
Typical Low / Median / Typical High
$26.92 / $48.98 / $79.43
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $245.47 / $3,630.78
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,479.11 / $2,570.40 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $371.54 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$190.55 / $190.55 / $295.12
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $123.03
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $2,951.21 / $3,235.94
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $323.59 / $562.34
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $302.00 / $630.96
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,819.70 / $2,691.53
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $676.08 / $3,090.30
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $630.96
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $588.84 / $1,047.13
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
$97.72 / $234.42 / $630.96
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$89.13 / $158.49 / $213.80