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Massachusetts rates for HCPCS 64494

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $616.60 / $3,019.95
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$295.12 / $741.31 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $102.33 / $371.54
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $177.83 / $537.03
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $741.31 / $2,818.38
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $107.15 / $257.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $134.90 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $117.49 / $223.87
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $69.18 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $138.04 / $190.55
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $3,467.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $114.82 / $245.47
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $851.14 / $2,454.71
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $60.26 / $131.83
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $741.31 / $2,818.38
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $107.15 / $257.04
Tufts
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $524.81
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $79.43 / $154.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,862.09 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $114.82 / $245.47