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Massachusetts rates for HCPCS 64490

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,905.46 / $3,388.44
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$234.42 / $2,089.30 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $204.17 / $562.34
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$162.18 / $398.11 / $1,096.48
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $1,862.09 / $30,199.52
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $229.09 / $575.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $123.03 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $288.40 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $251.19 / $478.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $204.17 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $295.12 / $407.38
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,511.89 / $7,079.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $245.47 / $537.03
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,905.46 / $3,388.44
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $269.15
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $1,862.09 / $30,199.52
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $229.09 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,454.71 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $245.47 / $549.54