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New Hampshire rates for HCPCS 64635

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $666.37 / $5,908.50
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,408.05 / $2,516.48 / $14,600.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.15 / $403.00 / $666.38
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$289.05 / $289.05 / $706.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.88 / $322.86 / $514.19
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$279.95 / $482.11 / $740.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.10 / $2,862.32 / $2,962.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.74 / $576.96 / $1,094.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.23 / $514.37 / $1,195.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,565.00 / $9,565.00 / $9,565.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.61 / $740.00 / $1,200.39
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.15 / $331.44 / $535.04