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Ohio rates for HCPCS 64625

Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

Facilitymedian $4,571 · 10th–90th $407$11,7490%5%10%10th90th$4,571Professionalmedian $339 · 10th–90th $182$7760%10%10th90th$339$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$295.12 / $5,128.61 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $407.38 / $1,949.84
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $257.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,884.03 / $7,943.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $234.42 / $371.54
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$257.04 / $346.74 / $537.03
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $316.23 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $512.86 / $977.24
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $467.74 / $870.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $2,398.83
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $489.78 / $741.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,479.11 / $4,168.69 / $6,760.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $467.74 / $831.76