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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
$1,065.35 / $2,084.03 / $2,201.21
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$537.75 / $2,146.19 / $2,530.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.29 / $171.49 / $2,253.60
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$124.44 / $280.68 / $1,564.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.97 / $141.97 / $280.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.97 / $141.97 / $141.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.67 / $152.41 / $285.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.55 / $137.58 / $189.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.53 / $184.10 / $338.94
Providence
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$51.53 / $52.83 / $75.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.45 / $281.02 / $325.39