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Arizona 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 $1,862 · 10th–90th $107$5,6230%5%10th90th$1,862Professionalmedian $93 · 10th–90th $49$3800%10%10th90th$93$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$363.08 / $2,398.83 / $5,623.41
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$630.96 / $1,862.09 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $87.10 / $295.12
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$120.23 / $302.00 / $489.78
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $79.43 / $91.20
Ambetter
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$64.57 / $117.49 / $134.90
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $501.19 / $912.01
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $63.10 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $89.13 / $154.88
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $93.33 / $1,412.54
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $2,511.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $1,122.02 / $2,137.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $79.43 / $134.90
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20