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Wisconsin 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 $1,318 · 10th–90th $85$4,7860%10%10th90th$1,318Professionalmedian $151 · 10th–90th $52$6460%5%10%10th90th$151$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$173.78 / $1,737.80 / $4,786.30
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$0.95 / $1,318.26 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $123.03 / $602.56
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $208.93 / $954.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,584.89 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $114.82 / $245.47
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$112.20 / $173.78 / $371.54
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $61.66 / $81.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $281.84 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $199.53 / $416.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $107.15 / $3,311.31
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $162.18 / $251.19
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$138.04 / $239.88 / $380.19
DeanCare
Facility/Professional
Professional
Modifier
80
Typical Low / Median / Typical High
$14.79 / $25.70 / $39.81
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $128.82 / $1,621.81
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$446.68 / $1,230.27 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $173.78 / $1,819.70
Medica
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$107.15 / $107.15 / $162.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $165.96 / $281.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $154.88 / $316.23
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $1,479.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $346.74 / $1,819.70
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $323.59
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $309.03 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,584.89 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $114.82 / $316.23
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$89.13 / $89.13 / $123.03