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Texas 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)

Facilitymedian $1,445 · 10th–90th $112$5,6230%5%10%10th90th$1,445Professionalmedian $85 · 10th–90th $47$2450%10%20%10th90th$85$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $1,905.46 / $7,413.10
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$724.44 / $1,318.26 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $85.11 / $218.78
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $165.96 / $512.86
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $79.43 / $112.20
Ambetter
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$69.18 / $125.89 / $177.83
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $977.24 / $3,801.89
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $74.13 / $114.82
Baylor Scott & White
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $446.68 / $1,071.52
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $87.10 / $154.88
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $309.03 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $95.50 / $169.82
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $1,479.11 / $1,698.24
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $1,819.70 / $1,819.70
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $123.03 / $3,162.28
Moda Health
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$446.68 / $1,318.26 / $2,511.89
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $87.10 / $177.83
Moda Health
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $181.97 / $676.08
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $32.36 / $72.44
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,019.95 / $3,311.31
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $93.33 / $169.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $95.50 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $954.99 / $2,398.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $75.86 / $131.83
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$89.13 / $89.13 / $199.53
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $95.50 / $97.72