go back

Ohio 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
$87.19 / $951.00 / $3,847.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$473.50 / $932.80 / $2,502.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.23 / $79.26 / $170.69
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$73.41 / $148.51 / $408.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.48 / $62.48 / $62.48
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$72.09 / $75.70 / $125.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$937.00 / $2,059.00 / $2,412.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.39 / $60.07 / $99.06
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$68.09 / $90.11 / $148.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.06 / $57.67 / $72.09
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.34 / $108.46 / $168.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.92 / $94.01 / $155.13
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.01 / $628.97 / $1,782.85
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.24 / $94.01 / $157.34
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$48.99 / $49.35 / $478.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.46 / $105.73 / $150.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $965.00 / $2,914.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.05 / $115.43 / $173.84