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Maryland 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
$86.76 / $457.05 / $2,001.74
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$101.32 / $866.24 / $2,228.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.16 / $172.27 / $463.51
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$124.44 / $301.39 / $1,530.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.57 / $99.93 / $199.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.00 / $451.23 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.99 / $177.28 / $356.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.14 / $237.17 / $357.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.00 / $158.00 / $424.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.02 / $236.44 / $392.64
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.63 / $211.43 / $261.63