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Texas 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
$178.00 / $1,839.00 / $6,386.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$980.04 / $2,387.34 / $6,467.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.95 / $155.43 / $267.86
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$124.44 / $271.77 / $835.65
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.05 / $111.93 / $201.53
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$136.82 / $173.53 / $287.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$719.23 / $1,258.68 / $2,720.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.20 / $141.08 / $224.83
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.42 / $1,585.87 / $3,228.35
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.50 / $101.51 / $197.66
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.05 / $957.23 / $957.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.97 / $153.97 / $153.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.97 / $187.13 / $308.14
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $452.96 / $30,000.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $3,100.00 / $3,100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.45 / $168.58 / $297.33
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.80 / $201.85 / $320.07
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$149.99 / $184.08 / $719.55
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,097.29 / $2,499.00 / $6,086.32
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.45 / $172.02 / $248.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.63 / $168.58 / $289.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.97 / $188.70 / $332.91
Providence
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$51.53 / $54.23 / $65.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.00 / $1,529.00 / $3,400.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.13 / $186.19 / $324.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.87 / $165.27 / $233.29