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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $2,398.83 / $5,623.41
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$630.96 / $1,862.09 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $87.10 / $295.12
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$120.23 / $338.84 / $489.78
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $77.62 / $109.65
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$66.07 / $117.49 / $138.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $363.08 / $537.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $63.10 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $89.13 / $154.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $93.33 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $120.23 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,412.54 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $79.43 / $131.83