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Montana rates for HCPCS 64490

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level

Facilitymedian $331 · 10th–90th $178$2,5700%20%10th90th$331Professionalmedian $229 · 10th–90th $102$8910%10%20%10th90th$229$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$537.03 / $1,778.28 / $2,884.03
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$537.03 / $537.03 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $204.17 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$151.36 / $338.84 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $165.96 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $177.83 / $302.00
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $316.23 / $346.74
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $316.23 / $346.74
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $223.87 / $371.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $199.53 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $245.47 / $354.81