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Louisiana rates for HCPCS 64494

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.26 / $973.00 / $3,500.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$289.56 / $737.75 / $1,730.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.69 / $84.51 / $145.59
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$112.41 / $134.41 / $134.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.42 / $60.42 / $81.69
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$71.23 / $93.87 / $229.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.64 / $423.75 / $1,298.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.38 / $93.22 / $139.19
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.28 / $302.04 / $302.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.62 / $88.07 / $141.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $543.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.16 / $104.50 / $195.76