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Massachusetts rates for HCPCS 64493

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $1,737.80 / $3,388.44
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$363.08 / $2,089.30 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $186.21 / $501.19
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$128.82 / $380.19 / $1,023.29
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $1,862.09 / $30,199.52
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $204.17 / $537.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $245.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $239.88 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $229.09 / $436.52
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $177.83 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $275.42 / $380.19
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,511.89 / $7,079.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $223.87 / $489.78
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $2,454.71 / $3,890.45
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $158.49 / $229.09
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $1,862.09 / $30,199.52
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $204.17 / $537.03
Tufts
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $1,288.25 / $2,344.23
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $158.49 / $302.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,454.71 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $218.78 / $512.86