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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)

Facilitymedian $603 · 10th–90th $65–$2,5120%10%10th90th$603Professionalmedian $98 · 10th–90th $50–$2950%10%20%10th90th$98$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
$489.78 / $1,230.27 / $5,888.44
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,412.54 / $1,412.54 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $89.13 / $186.21
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$323.59 / $323.59 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $134.90 / $288.40
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $204.17 / $1,230.27
Moda Health
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$0.98 / $1,412.54 / $1,905.46
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $229.09 / $467.74
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $346.74 / $467.74
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $144.54 / $426.58
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $104.71 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $147.91 / $457.09