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Tennessee rates for HCPCS 64491

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.39 / $1,310.98 / $4,069.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$376.18 / $2,645.10 / $3,220.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.09 / $87.53 / $158.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$82.64 / $130.91 / $452.01
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$131.82 / $146.36 / $176.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $148.00 / $1,676.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $103.33 / $169.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.67 / $104.62 / $176.42
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $289.37 / $289.37
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.00 / $2,750.00 / $2,750.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $808.00 / $2,577.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.40 / $118.94 / $221.58