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North Carolina 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
$83.18 / $851.14 / $5,248.07
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$549.54 / $2,951.21 / $2,951.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $87.10 / $199.53
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $173.78 / $389.05
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $120.23 / $190.55
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$81.28 / $123.03 / $257.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $204.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $134.90 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $104.71 / $181.97
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $213.80
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $89.13 / $147.91
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $134.90 / $186.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $758.58 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $85.11 / $162.18
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $323.59 / $2,630.27
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89