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Pennsylvania 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
$91.20 / $1,584.89 / $7,244.36
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$275.42 / $851.14 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $87.10 / $263.03
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $173.78 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $60.26
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$83.18 / $91.20 / $134.90
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,258.93 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $128.82 / $169.82
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$131.83 / $194.98 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $91.20 / $154.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $162.18 / $204.17
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $117.49 / $165.96
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $562.34 / $1,995.26
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$467.74 / $3,715.35 / $3,801.89
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $1,348.96 / $7,244.36
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$275.42 / $851.14 / $3,981.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $95.50 / $234.42
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $199.53 / $489.78
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $741.31 / $6,606.93
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $123.03 / $194.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $91.20 / $208.93
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $93.33 / $218.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $676.08 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $85.11 / $144.54