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Texas rates for HCPCS 64400

Injection Aa&/Strd Trigeminal Nerve Each Branch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.38 / $1,791.00 / $6,691.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.01 / $99.42 / $157.41
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$54.53 / $163.58 / $830.88
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.26 / $159.19 / $160.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.15 / $111.70 / $426.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.41 / $91.48 / $150.82
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.70 / $299.06 / $650.95
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.84 / $41.87 / $125.12
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.16 / $365.64 / $365.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.90 / $87.90 / $87.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.80 / $121.94 / $208.54
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $254.27
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.00 / $1,030.00 / $1,030.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.71 / $110.59 / $189.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.01 / $125.36 / $196.22
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.31 / $113.27 / $218.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.71 / $110.59 / $189.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.39 / $126.16 / $219.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $1,058.00 / $2,668.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.58 / $121.70 / $194.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.04 / $104.27 / $147.12