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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

Facilitymedian $309 · 10th–90th $155$2,5120%10%20%10th90th$309Professionalmedian $214 · 10th–90th $87$6760%10%10th90th$214$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
$676.08 / $1,348.96 / $2,187.76
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$537.03 / $2,137.96 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $173.78 / $467.74
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$123.03 / $281.84 / $1,023.29
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
$141.25 / $239.88 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $151.36 / $281.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $288.40 / $316.23
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $288.40 / $316.23
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $190.55 / $323.59
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $169.82 / $346.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $239.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $208.93 / $323.59