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California 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
$851.14 / $4,897.79 / $15,848.93
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$794.33 / $1,445.44 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $89.13 / $363.08
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $134.90 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $43.65 / $51.29
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$85.11 / $117.49 / $257.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $4,466.84 / $12,882.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $89.13 / $181.97
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$72.44 / $109.65 / $158.49
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $223.87 / $5,888.44
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $83.18 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $97.72 / $177.83
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $74.13 / $151.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $100.00 / $194.98
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $2,630.27
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $128.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $97.72 / $169.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $100.00 / $186.21
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $295.12
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $109.65 / $141.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,584.89 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $75.86 / $158.49