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Texas 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
$97.76 / $1,856.00 / $6,386.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$808.14 / $1,280.40 / $2,038.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $87.28 / $153.28
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$85.62 / $146.91 / $508.59
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.52 / $64.11 / $116.62
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$86.37 / $137.37 / $145.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.43 / $977.71 / $3,989.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.64 / $77.37 / $123.11
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.79 / $58.79 / $58.79
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.18 / $109.30 / $159.80
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.19 / $399.36 / $399.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.68 / $101.68 / $101.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.08 / $107.88 / $174.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $289.37
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.00 / $2,750.00 / $2,750.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.90 / $95.04 / $159.55
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.84 / $107.10 / $170.60
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$95.54 / $111.18 / $166.91
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.99 / $2,499.00 / $5,812.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.34 / $95.60 / $136.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.91 / $96.16 / $160.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.27 / $111.98 / $186.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $950.00 / $2,405.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.09 / $103.29 / $166.87
United
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$204.69 / $204.69 / $204.69
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.89 / $91.58 / $128.30