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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
$106.23 / $861.66 / $1,698.41
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,292.49 / $1,546.62 / $2,603.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.41 / $157.28 / $233.94
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,870.45 / $1,870.45 / $2,992.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.49 / $115.87 / $178.91
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$147.72 / $173.81 / $268.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.98 / $197.10 / $360.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.53 / $219.29 / $352.05
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.42 / $1,141.79 / $1,724.62
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$308.74 / $1,546.62 / $2,558.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.73 / $159.12 / $248.23
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,870.45 / $1,870.45 / $2,992.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.12 / $231.17 / $361.43