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Vermont 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
$2,511.89 / $2,511.89 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $218.78 / $724.44
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$281.84 / $562.34 / $1,148.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $213.80 / $363.08
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $269.15 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $257.04 / $478.63