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Montana rates for HCPCS 64494

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)

Facilitymedian $155 · 10th–90th $85$1,5140%20%10th90th$155Professionalmedian $115 · 10th–90th $50$4070%10%10th90th$115$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
$537.03 / $676.08 / $1,513.56
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$575.44 / $1,071.52 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $95.50 / $407.38
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$72.44 / $134.90 / $407.38
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 / $123.03 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $79.43
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $87.10 / $144.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $107.15 / $158.49
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $107.15 / $158.49
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $102.33 / $162.18
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $95.50 / $177.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $100.00 / $162.18