go back

Maine 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
$288.40 / $1,288.25 / $1,698.24
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$309.03 / $1,621.81 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $177.83 / $346.74
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$138.04 / $295.12 / $575.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $138.04 / $213.80
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$123.03 / $204.17 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $208.93 / $363.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $234.42 / $380.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $1,288.25 / $1,737.80
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$309.03 / $1,621.81 / $3,981.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $186.21 / $371.54
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$144.54 / $371.54 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $165.96 / $331.13