go back

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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,398.83 / $9,772.37
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $87.10 / $165.96
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$234.42 / $380.19 / $630.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $100.00 / $141.25
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$67.61 / $151.36 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $123.03 / $223.87
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $117.49 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $112.20 / $208.93
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $112.20
Well Sense
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$104.71 / $104.71 / $104.71