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Tennessee rates for HCPCS 64493

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,288.25 / $2,691.53
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$501.19 / $2,089.30 / $3,548.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $169.82 / $398.11
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$125.89 / $288.40 / $933.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $123.03 / $239.88
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$125.89 / $234.42 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,513.56 / $2,137.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $194.98 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $181.97 / $302.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $30,199.52
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,090.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,445.44 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $162.18 / $323.59