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New Hampshire 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 $1,413 · 10th–90th $78–$8,9130%10%10th90th$1,413Professionalmedian $105 · 10th–90th $52–$2240%10%10th90th$105$1.0$5.0$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
$77.62 / $1,047.13 / $8,912.51
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$0.74 / $2,089.30 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $100.00 / $223.87
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$72.44 / $165.96 / $537.03
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $45.71 / $70.79
Ambetter
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$66.07 / $66.07 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $100.00 / $141.25
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$66.07 / $147.91 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $123.03 / $223.87
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $109.65 / $213.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $112.20 / $218.78
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $26.92 / $112.20
Well Sense
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$114.82 / $114.82 / $114.82