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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $87.10 / $177.83
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $128.82 / $380.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $77.62 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$67.61 / $114.82 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $112.20 / $186.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $123.03 / $194.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,288.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $97.72 / $190.55
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$74.13 / $134.90 / $380.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $87.10 / $169.82