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New Hampshire 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)

Facilitymedian $1,820 · 10th–90th $87$8,9130%10%10th90th$1,820Professionalmedian $170 · 10th–90th $65$5250%10%10th90th$170$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $1,819.70 / $9,772.37
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$0.74 / $1,230.27 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $177.83 / $537.03
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$83.18 / $190.55 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $204.17 / $213.80
Ambetter
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$70.79 / $70.79 / $1,148.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $114.82 / $165.96
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$75.86 / $173.78 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $177.83 / $549.54
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $204.17 / $562.34
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $181.97 / $512.86
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $93.33 / $302.00
Well Sense
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$316.23 / $316.23 / $316.23