go back

Utah 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
$933.25 / $3,311.31 / $7,079.46
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$891.25 / $2,754.23 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $218.78 / $724.44
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$81.28 / $158.49 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $169.82 / $371.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $169.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $181.97 / $478.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $251.19 / $407.38
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $338.84 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $134.90 / $275.42