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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

Facilitymedian $1,549 · 10th–90th $295–$2,6300%10%20%10th90th$1,549Professionalmedian $209 · 10th–90th $95–$4470%5%10%10th90th$209$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $1,288.25 / $1,698.24
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$309.03 / $1,621.81 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $190.55 / $380.19
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$208.93 / $436.52 / $575.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $138.04 / $194.98
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$123.03 / $204.17 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $208.93 / $371.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $234.42 / $380.19
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $107.15 / $234.42
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $181.97 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $177.83 / $371.54
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$363.08 / $363.08 / $380.19