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Maine 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
$1,202.26 / $2,398.83 / $2,754.23
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$346.74 / $1,380.38 / $2,630.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $194.98 / $354.81
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$208.93 / $524.81 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $158.49 / $251.19
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$141.25 / $239.88 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $239.88 / $398.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $251.19 / $407.38
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $2,398.83 / $2,754.23
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$346.74 / $1,380.38 / $2,630.27
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $204.17 / $371.54
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$208.93 / $524.81 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $186.21 / $371.54