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North Carolina 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
$143.54 / $1,111.01 / $3,598.65
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$944.65 / $3,635.22 / $6,210.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.29 / $170.90 / $364.79
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$130.34 / $282.69 / $782.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.00 / $230.00 / $293.18
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$221.92 / $225.48 / $439.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.69 / $263.19 / $440.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $820.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.57 / $201.54 / $366.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.72 / $196.54 / $272.85
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$247.32 / $319.11 / $511.28
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.00 / $211.00 / $228.00
Medcost
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$319.11 / $319.11 / $319.11
Medcost
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$42.55 / $42.55 / $42.55
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,204.63 / $1,204.63 / $1,204.63
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.93 / $234.80 / $301.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$554.00 / $2,417.00 / $4,102.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.22 / $253.17 / $444.65
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.13 / $452.96 / $30,000.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $3,100.00