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Montana rates for HCPCS 64495

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

Facilitymedian $151 · 10th–90th $87$1,0230%20%10th90th$151Professionalmedian $95 · 10th–90th $50$2750%20%10th90th$95$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
$602.56 / $602.56 / $1,023.29
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $89.13 / $269.15
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$74.13 / $141.25 / $398.11
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
$72.44 / $81.28 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $89.13 / $144.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $109.65 / $158.49
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $109.65 / $158.49
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $104.71 / $165.96
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $93.33 / $173.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $100.00 / $162.18