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Montana rates for HCPCS 64491

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure)

Facilitymedian $135 · 10th–90th $100–$1860%20%40%10th90th$135Professionalmedian $129 · 10th–90th $58–$3890%10%20%10th90th$129$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$1,174.90 / $1,348.96 / $1,348.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $112.20 / $316.23
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$83.18 / $147.91 / $389.05
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64,565.42 / $77,624.71 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $93.33 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $102.33 / $154.88
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $123.03 / $169.82
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $123.03 / $169.82
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $112.20 / $181.97
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $102.33 / $190.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $120.23 / $177.83