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Pennsylvania rates for HCPCS 64625

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

Facilitymedian $5,129 · 10th–90th $1,023$8,5110%10%10th90th$5,129Professionalmedian $447 · 10th–90th $182$1,1220%10%20%10th90th$447$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
$1,023.29 / $5,370.32 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $436.52 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$478.63 / $478.63 / $478.63
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $6,165.95 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $467.74 / $812.83
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$676.08 / $707.95 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $467.74 / $891.25
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $851.14
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $549.54 / $812.83
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,388.44 / $3,890.45 / $8,709.64
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$8,912.51 / $8,912.51 / $8,912.51
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $4,265.80 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $416.87 / $912.01
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $891.25 / $1,047.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $295.12 / $537.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $295.12 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $3,715.35 / $6,309.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $467.74 / $851.14