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Myelogram Of The Lower Back, Injection And X-ray Imaging

Wisconsin rates for HCPCS 62304

A dye study of the lower back and tailbone portion of the spine. Contrast dye is injected through a needle into the fluid-filled space around the spinal cord and nerve roots, and x-ray images are then taken and interpreted. The injection and the imaging are both part of this service.

Rates data updated July 2026.

Facilitymedian $2,818 · 10th–90th $240$5,4950%10%10th90th$2,818Professionalmedian $347 · 10th–90th $110$1,0000%10%10th90th$347$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
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$512.86
Typical High
$3,090.30
Aetna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$239.88
Typical High
$1,318.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$3,090.30
Typical High
$5,754.40
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$245.47
Typical High
$630.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$776.25
Typical High
$1,230.27
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$457.09
Typical High
$1,148.15
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$263.03
Typical High
$3,311.31
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$398.11
Typical High
$741.31
Medica
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$275.42
Typical High
$3,630.78
Medica
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$537.03
Typical High
$1,862.09
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$3,019.95
Typical High
$3,235.94
Network Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$537.03
Typical High
$1,122.02
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$234.42
Typical High
$436.52
Quartz
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$380.19
Typical High
$831.76
Quartz
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$776.25
Typical High
$776.25
Quartz
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$549.54
Typical High
$1,778.28
Security Health
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$933.25
Security Health
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$831.76
Typical High
$1,479.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$2,818.38
Typical High
$4,365.16
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$478.63
Typical High
$891.25