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Washington rates for HCPCS 61790

Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,616.64 / $5,128.00 / $18,800.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,409.54 / $5,750.27 / $14,156.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.02 / $1,315.02 / $2,190.81
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,075.84 / $1,793.31 / $4,809.85
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,248.56 / $1,695.77 / $1,809.67
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$848.85 / $1,194.56 / $1,234.35
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,913.81 / $5,468.48 / $10,466.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,550.00 / $2,431.00 / $11,261.00