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Wyoming 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
$295.12 / $602.56 / $1,023.29
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $91.20 / $208.93
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $141.25 / $302.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $199.53 / $295.12
BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$102.33 / $186.21 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $117.49 / $218.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $131.83 / $275.42