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New Hampshire 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 $1,622 · 10th–90th $138$5,8880%10%10th90th$1,622Professionalmedian $200 · 10th–90th $98$4370%5%10%10th90th$200$20.0$100.0$500.0$2.0K$10.0K

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
$138.04 / $407.38 / $8,912.51
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,148.15 / $2,818.38 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $186.21 / $354.81
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$147.91 / $288.40 / $912.01
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $83.18 / $194.98
Ambetter
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$123.03 / $123.03 / $295.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,412.54 / $3,467.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $177.83 / $251.19
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$123.03 / $269.15 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $234.42 / $446.68
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,943.28 / $7,943.28 / $7,943.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $218.78 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,943.28 / $7,943.28 / $7,943.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $218.78 / $467.74
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $46.77 / $218.78
Well Sense
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$223.87 / $223.87 / $223.87