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Montana rates for HCPCS 64492

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; 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
$1,164.15 / $1,164.15 / $1,164.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.07 / $94.12 / $1,068.85
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$132.35 / $211.29 / $457.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $94.12 / $154.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.12 / $94.12 / $94.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.33 / $102.43 / $156.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.25 / $75.50 / $103.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.04 / $116.93 / $188.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.55 / $156.19 / $175.37