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Oklahoma 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
$79.43 / $1,380.38 / $6,456.54
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$562.34 / $676.08 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $85.11 / $173.78
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $128.82 / $380.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $77.62 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$70.79 / $117.49 / $151.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,691.53 / $4,365.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $87.10 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $100.00 / $141.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $102.33 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $102.33 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $630.96 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $70.79 / $114.82