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Arizona rates for HCPCS 64494

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $1,671.00 / $5,506.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$660.00 / $1,320.00 / $2,409.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.93 / $84.51 / $474.05
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$70.41 / $148.51 / $494.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.89 / $81.89 / $228.43
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$72.53 / $122.84 / $161.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.71 / $446.91 / $730.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.71 / $48.01 / $72.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.09 / $90.11 / $151.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.94 / $87.92 / $1,203.00
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,088.44 / $2,088.44 / $2,088.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.18 / $106.68 / $483.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.00 / $1,535.00 / $2,175.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.43 / $93.98 / $179.88