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Maine rates for HCPCS 64495

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

Facilitymedian $794 · 10th–90th $794–$1,2880%50%90th$794Professionalmedian $91 · 10th–90th $51–$1860%5%10%10th90th$91$50.0$100.0$200.0$500.0$1.0K

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
$794.33 / $794.33 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $87.10 / $162.18
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$134.90 / $134.90 / $380.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $74.13 / $112.20
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$67.61 / $109.65 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $112.20 / $190.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $123.03 / $194.98
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $91.20 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $91.20 / $186.21
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98