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New York 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
$76.17 / $2,159.00 / $10,170.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$610.64 / $1,644.79 / $22,901.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.94 / $89.83 / $272.56
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$73.41 / $148.52 / $439.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $3,373.00 / $4,707.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.42 / $87.83 / $210.54
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$105.07 / $131.74 / $317.83
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.33 / $73.33 / $16,534.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.33 / $73.33 / $129.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.87 / $86.87 / $14,648.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $113.27 / $305.91
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $66.65 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.33 / $149.46 / $924.02
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.44 / $84.44 / $84.44
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.27 / $105.88 / $192.31
Fidelis
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$146.72 / $146.72 / $251.75
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.09 / $199.46 / $1,227.00
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$100.50 / $234.61 / $1,840.50
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.83 / $126.28 / $127.67
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$189.42 / $189.42 / $190.47
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.87 / $555.00 / $36,596.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.48 / $118.95 / $303.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.00 / $2,826.00 / $4,851.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.03 / $122.70 / $271.89
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.09 / $59.09 / $170.08
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.09 / $115.79 / $192.31