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Texas 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
$345.58 / $2,038.25 / $5,906.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$897.60 / $1,662.04 / $3,649.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.29 / $172.53 / $355.66
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$85.23 / $158.91 / $835.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.95 / $200.87 / $261.81
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$88.64 / $104.66 / $343.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.88 / $1,283.82 / $3,989.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.59 / $171.97 / $308.85
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.00 / $906.80 / $3,041.11
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.47 / $116.25 / $377.44
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.19 / $521.55 / $521.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.61 / $100.61 / $100.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.50 / $137.26 / $332.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $429.16 / $1,700.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.44 / $1,679.92 / $1,965.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.93 / $165.40 / $355.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.59 / $105.89 / $407.57
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$110.53 / $110.53 / $110.53
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$828.48 / $1,133.33 / $5,207.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.07 / $215.20 / $479.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $165.40 / $361.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.67 / $144.28 / $357.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $950.00 / $2,405.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.61 / $191.80 / $305.54
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.25 / $215.99 / $307.33