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Vermont 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
$2,089.30 / $2,089.30 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $190.55 / $630.96
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$147.91 / $302.00 / $1,047.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $2,041.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $186.21 / $331.13
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $245.47 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $234.42 / $436.52