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Maryland rates for HCPCS 64625

Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $478.63 / $1,071.52
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $204.17 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $489.78 / $1,258.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $575.44 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $501.19 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $457.09 / $851.14
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $602.56 / $758.58