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Wisconsin 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 $1,096 · 10th–90th $48$3,4670%10%20%10th90th$1,096Professionalmedian $110 · 10th–90th $50$3160%10%10th90th$110$1.0$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
$0.83 / $186.21 / $3,467.37
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $87.10 / $257.04
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$125.89 / $338.84 / $436.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,584.89 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $251.19
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$112.20 / $165.96 / $380.19
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $281.84 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $204.17 / $416.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $107.15 / $3,311.31
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $162.18 / $251.19
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$141.25 / $239.88 / $371.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $117.49 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $173.78 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $169.82 / $281.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $158.49 / $323.59
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $2,630.27
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $346.74 / $2,511.89
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $323.59
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $309.03 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,584.89 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $114.82 / $316.23
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20