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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)

Facilitymedian $525 · 10th–90th $1–$1,2590%10%10th90th$525Professionalmedian $115 · 10th–90th $54–$2510%10%10th90th$115$1.0$5.0$20.0$100.0$500.0$2.0K

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
$1.45 / $302.00 / $1,288.25
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1.45 / $524.81 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $100.00 / $213.80
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$97.72 / $218.78 / $363.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $74.13 / $109.65
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$66.07 / $112.20 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $112.20 / $190.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $117.49 / $190.55
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $93.33 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $91.20 / $181.97
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53