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Montana rates for HCPCS 64493

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,348.96 / $2,187.76
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$537.03 / $2,137.96 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $173.78 / $691.83
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$123.03 / $281.84 / $1,513.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $239.88 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $151.36 / $281.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $288.40 / $316.23
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $288.40 / $316.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $181.97 / $323.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $169.82 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $186.21 / $309.03