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Oregon 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
$114.82 / $263.03 / $6,606.93
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$794.33 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $87.10 / $257.04
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $128.82 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $123.03 / $229.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $131.83 / $239.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $107.15 / $263.03
Moda Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$794.33 / $794.33 / $794.33
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $141.25 / $234.42
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $128.82 / $436.52
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $165.96 / $181.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $107.15 / $194.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $128.82 / $223.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $154.88 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $4,073.80 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $128.82 / $218.78