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Texas 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
$524.81 / $2,089.30 / $7,413.10
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$776.25 / $2,089.30 / $5,248.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $186.21 / $467.74
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$154.88 / $389.05 / $1,122.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $169.82 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$144.54 / $257.04 / $316.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,288.25 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $154.88 / $239.88
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,230.27 / $2,344.23
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $144.54 / $245.47
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $1,000.00 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $208.93 / $354.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $30,199.52 / $30,199.52
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $245.47 / $3,467.37
Moda Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$724.44 / $2,089.30 / $7,413.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $186.21 / $371.54
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$154.88 / $323.59 / $1,096.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $32.36 / $154.88
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $3,019.95 / $3,388.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $363.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $199.53 / $363.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $204.17 / $354.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,778.28 / $4,168.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $162.18 / $309.03
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $208.93 / $208.93