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Montana rates for HCPCS 64625

Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

Facilitymedian $813 · 10th–90th $316–$3,9810%20%40%10th90th$813Professionalmedian $479 · 10th–90th $191–$1,0720%10%10th90th$479$100.0$500.0$2.0K$10.0K$50.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $478.63 / $1,174.90
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
$309.03 / $309.03 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $478.63 / $741.31
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $794.33 / $870.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $794.33 / $870.96
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $309.03 / $616.60
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $309.03 / $776.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $3,981.07
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $537.03 / $891.25