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Tennessee 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
$467.74 / $1,380.38 / $3,981.07
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$562.34 / $562.34 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $85.11 / $186.21
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$87.10 / $173.78 / $380.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $56.23 / $109.65
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$70.79 / $123.03 / $239.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $151.36 / $1,621.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $104.71 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $93.33 / $154.88
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $323.59 / $2,630.27
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $812.83 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $85.11 / $162.18