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Michigan 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 $1,445 · 10th–90th $69–$4,8980%10%20%10th90th$1,445Professionalmedian $87 · 10th–90th $49–$2340%10%10th90th$87$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
$67.61 / $2,041.74 / $4,897.79
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $83.18 / $173.78
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $134.90 / $489.78
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $75.86
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $144.54 / $151.36
BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$162.18 / $162.18 / $288.40
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $91.20
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $83.18 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $79.43 / $134.90
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $616.60 / $4,897.79
Health Alliance Plan
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $97.72 / $177.83
Health Alliance Plan
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $128.82 / $489.78
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $75.86 / $123.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $1,202.26 / $2,041.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $81.28 / $125.89