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New Hampshire 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 $2,399 · 10th–90th $1,820–$9,7720%20%10th90th$2,399Professionalmedian $105 · 10th–90th $58–$2190%10%10th90th$105$50.0$200.0$1.0K$5.0K

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
$1,819.70 / $2,398.83 / $9,772.37
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$2,344.23 / $2,344.23 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $95.50 / $190.55
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$288.40 / $380.19 / $630.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $100.00 / $141.25
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$67.61 / $151.36 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $123.03 / $229.09
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
$54.95 / $114.82 / $223.87
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
$56.23 / $114.82 / $223.87
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $27.54 / $112.20
Well Sense
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$114.82 / $114.82 / $114.82