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Maryland 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 $48 · 10th–90th $1–$2000%10%20%10th90th$48Professionalmedian $91 · 10th–90th $49–$2690%10%20%10th90th$91$1.0$5.0$20.0$100.0$500.0$2.0K

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
$0.98 / $47.86 / $199.53
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $89.13 / $263.03
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $138.04 / $398.11
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $56.23 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $93.33 / $177.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $117.49 / $177.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $40.74 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $85.11 / $154.88
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $120.23 / $147.91