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Washington 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)

Facilitymedian $135 · 10th–90th $68$7,9430%10%10th90th$135Professionalmedian $105 · 10th–90th $51$2950%10%10th90th$105$5.0$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $524.81 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $93.33 / $295.12
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$77.62 / $141.25 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $43.65 / $91.20
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $537.03
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$794.33 / $794.33 / $794.33
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $128.82 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $707.95 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $117.49 / $239.88
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $112.20 / $208.93
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $114.82 / $213.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $52.48
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $165.96 / $177.83
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $125.89
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $223.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $537.03
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$630.96 / $630.96 / $794.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $123.03 / $213.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $549.54 / $5,754.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $112.20 / $199.53
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $91.20 / $144.54