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Oklahoma 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
$229.09 / $1,445.44 / $6,309.57
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$676.08 / $1,995.26 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $181.97 / $691.83
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$81.28 / $199.53 / $831.76
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $194.98 / $281.84
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$77.62 / $295.12 / $467.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,691.53 / $4,365.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $162.18 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $107.15 / $309.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $229.09 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $204.17 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $630.96 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $114.82 / $239.88