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Montana rates for HCPCS 64484

Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $794.33 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $112.20 / $588.84
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$69.18 / $144.54 / $204.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $85.11 / $173.78
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $107.15 / $194.98
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $107.15 / $194.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $117.49 / $223.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $97.72 / $229.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $117.49 / $190.55