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Montana 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
$575.44 / $2,454.71 / $3,090.30
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$512.86 / $1,513.56 / $3,548.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $186.21 / $1,174.90
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$81.28 / $186.21 / $457.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $100.00 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $100.00 / $338.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $123.03 / $426.58
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $123.03 / $426.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $199.53 / $363.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $117.49 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $154.88 / $316.23