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Kansas 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
$114.82 / $3,162.28 / $7,943.28
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$954.99 / $1,862.09 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $85.11 / $199.53
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$79.43 / $295.12 / $380.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $50.12 / $85.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $1,071.52 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $97.72 / $165.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $107.15 / $478.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $128.82 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $537.03 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $89.13 / $138.04