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Maine rates for HCPCS 64636

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $933.25 / $1,819.70
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$588.84 / $1,023.29 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $194.98 / $630.96
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$91.20 / $199.53 / $1,621.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $89.13 / $199.53
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$75.86 / $131.83 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $141.25 / $457.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $199.53 / $501.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $933.25 / $1,819.70
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$588.84 / $1,023.29 / $2,511.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $186.21 / $446.68
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$85.11 / $181.97 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $144.54 / $363.08