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Louisiana rates for HCPCS 64495

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $1,288.25 / $3,715.35
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$645.65 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $89.13 / $154.88
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$77.62 / $134.90 / $338.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $48.98 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$70.79 / $77.62 / $151.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $239.88 / $1,230.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $85.11 / $138.04
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $316.23 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $89.13 / $144.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $512.86 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $83.18 / $151.36