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Louisiana rates for HCPCS 64490

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $1,288.25 / $3,715.35
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$831.76 / $2,454.71 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $199.53 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$213.80 / $338.84 / $5,754.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $123.03 / $199.53
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$131.83 / $177.83 / $288.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $1,230.27 / $1,949.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $181.97 / $295.12
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $1,000.00 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $186.21 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $1,096.48 / $2,344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $177.83 / $331.13