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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)

Facilitymedian $132 · 10th–90th $102–$1820%20%10th90th$132Professionalmedian $110 · 10th–90th $59–$3020%10%20%10th90th$110$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
$1,174.90 / $1,174.90 / $1,174.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $104.71 / $302.00
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$131.83 / $165.96 / $457.09
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
$79.43 / $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
$102.33 / $125.89 / $169.82
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $125.89 / $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
$79.43 / $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
$89.13 / $120.23 / $177.83