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Maryland rates for HCPCS 64636

Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $39.36 / $697.20
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$0.98 / $488.40 / $1,289.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.85 / $181.49 / $725.96
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$81.45 / $216.78 / $458.76
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.55 / $63.97 / $81.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.00 / $330.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.54 / $168.83 / $398.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.22 / $313.22 / $410.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $36.00 / $41.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.79 / $212.17 / $352.39
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.80 / $279.23 / $344.59