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Myelogram Of The Lower Back, Injection And X-ray Imaging

New Hampshire rates for HCPCS 62304

A dye study of the lower back and tailbone portion of the spine. Contrast dye is injected through a needle into the fluid-filled space around the spinal cord and nerve roots, and x-ray images are then taken and interpreted. The injection and the imaging are both part of this service.

Rates data updated July 2026.

Facilitymedian $1,413 · 10th–90th $955$8,9130%20%10th90th$1,413Professionalmedian $251 · 10th–90th $123$5500%10%10th90th$251$100.0$200.0$500.0$1.0K$2.0K$5.0K$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
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$9,772.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$229.09
Typical High
$371.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$1,412.54
Typical High
$2,630.27
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$213.80
Typical High
$316.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$2,570.40
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$302.00
Typical High
$616.60
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$3,630.78
Median
$3,630.78
Typical High
$7,943.28
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$281.84
Typical High
$575.44
United
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$3,630.78
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$302.00
Typical High
$660.69
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$87.10