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Alaska rates for HCPCS 64495

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,230.27 / $5,888.44
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $89.13 / $218.78
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$323.59 / $323.59 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $218.78 / $389.05
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $323.59 / $2,511.89
Moda Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$0.98 / $0.98 / $1,905.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $245.47 / $467.74
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $288.40 / $489.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $131.83 / $426.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $104.71 / $223.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $229.09 / $457.09