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Maine rates for HCPCS 64491

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)

Facilitymedian $759 · 10th–90th $1–$1,9500%10%20%10th90th$759Professionalmedian $107 · 10th–90th $62–$2090%10%10th90th$107$1.0$5.0$20.0$100.0$500.0

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.72 / $213.80 / $1,949.84
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$194.98 / $977.24 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $104.71 / $204.17
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$97.72 / $109.65 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $85.11 / $125.89
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$75.86 / $128.82 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $120.23 / $204.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $204.17
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $100.00 / $177.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $100.00 / $194.98