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Maine 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
$1.45 / $302.00 / $1,288.25
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1.45 / $524.81 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $97.72 / $194.98
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $162.18 / $416.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $75.86 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$66.07 / $114.82 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $112.20 / $181.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $117.49 / $190.55
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $302.00 / $2,630.27
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$0.89 / $302.00 / $660.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $100.00 / $194.98
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $213.80 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $87.10 / $165.96