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Washington rates for HCPCS 64634

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.60 / $636.33 / $10,122.46
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$662.41 / $662.41 / $3,185.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.02 / $197.18 / $604.14
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$93.56 / $200.16 / $574.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.19 / $64.19 / $64.19
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$180.04 / $180.04 / $180.04
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $355.61 / $531.49
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$797.24 / $797.24 / $797.24
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.86 / $450.11 / $2,060.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$174.09 / $202.53 / $736.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $714.97 / $870.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.87 / $210.36 / $726.68
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $183.94 / $490.09
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$666.96 / $666.96 / $666.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.65 / $183.94 / $493.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.05 / $352.15 / $629.43
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.52 / $384.88 / $513.89
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.52 / $350.52 / $355.61
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.41 / $200.03 / $611.63
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.87 / $421.87 / $531.49
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$632.80 / $632.80 / $797.24
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.08 / $215.36 / $577.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.00 / $546.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.96 / $353.23 / $702.92
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.81 / $205.94 / $285.29