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Vermont 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
$2,089.30 / $2,089.30 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $93.33 / $223.87
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$288.40 / $489.78 / $501.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $100.00 / $169.82
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $123.03 / $151.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $120.23 / $208.93