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New Hampshire 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $1,122.02 / $8,912.51
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $100.00 / $218.78
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$162.18 / $331.13 / $562.34
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $104.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $117.49 / $162.18
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$75.86 / $173.78 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $134.90 / $245.47
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $120.23 / $234.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $123.03 / $223.87
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $117.49
Well Sense
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$109.65 / $109.65 / $109.65