go back

Minnesota 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
$0.79 / $91.20 / $125.89
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $85.11 / $229.09
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$77.62 / $234.42 / $436.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2,041.74 / $7,079.46
BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$0.02 / $0.02 / $0.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $162.18 / $309.03
BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$134.90 / $234.42 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $338.84 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $204.17 / $380.19
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $323.59 / $645.65
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $199.53 / $346.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $125.89 / $331.13
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $173.78 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,862.09 / $3,467.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $125.89 / $269.15