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Missouri 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
$70.79 / $1,230.27 / $5,623.41
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,148.15 / $1,548.82 / $1,548.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $89.13 / $309.03
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$93.33 / $208.93 / $501.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $43.65 / $51.29
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$70.79 / $70.79 / $70.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,819.70 / $4,168.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $60.26 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$70.79 / $91.20 / $147.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $97.72 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $97.72 / $173.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $95.50 / $467.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $144.54 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $707.95 / $1,778.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $91.20 / $162.18