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Wyoming 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
$292.20 / $2,201.21 / $2,201.21
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$537.75 / $2,146.19 / $3,510.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.71 / $357.30 / $2,430.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$130.22 / $395.72 / $6,070.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$974.00 / $974.00 / $974.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.00 / $292.00 / $576.00
BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$271.50 / $525.00 / $864.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.67 / $227.13 / $392.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.00 / $788.00 / $3,328.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.08 / $354.97 / $583.70