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Iowa 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
$123.03 / $2,290.87 / $6,760.83
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$281.84 / $1,318.26 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $89.13 / $295.12
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$79.43 / $288.40 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $147.91 / $269.15
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $109.65 / $512.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $141.25 / $1,348.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $169.82 / $389.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $169.82 / $239.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $169.82 / $229.09
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,621.81 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $104.71 / $229.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $134.90 / $204.17