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Maine rates for HCPCS 64490

Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 1 Level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.79 / $1,209.04 / $2,753.35
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,390.06 / $2,603.64 / $2,603.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.85 / $175.65 / $254.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.66 / $136.08 / $207.09
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$173.50 / $204.12 / $310.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.47 / $231.41 / $400.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.26 / $237.43 / $381.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,209.04 / $1,336.43 / $2,753.35
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$347.04 / $1,390.06 / $2,603.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.79 / $177.69 / $291.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.37 / $255.14 / $392.07