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Missouri 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)

Facilitymedian $1,288 · 10th–90th $89$3,8900%5%10th90th$1,288Professionalmedian $110 · 10th–90th $50$4170%5%10%10th90th$110$10.0$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
$70.79 / $1,174.90 / $5,248.07
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$575.44 / $1,778.28 / $2,951.21
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $100.00 / $380.19
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$72.44 / $144.54 / $501.19
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $43.65 / $83.18
Ambetter
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$61.66 / $75.86 / $125.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,819.70 / $4,168.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $60.26 / $97.72
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$70.79 / $89.13 / $144.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $95.50 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $97.72 / $173.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $104.71 / $741.31
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$724.44 / $724.44 / $1,318.26
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $147.91 / $1,819.70
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $707.95 / $2,041.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $89.13 / $154.88