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California rates for HCPCS 61791

Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $7,585.78 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $5,888.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $7,943.28 / $16,982.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,862.09 / $3,715.35
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $2,041.74 / $8,709.64
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,513.56 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $57,543.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,348.96 / $2,818.38
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,230.27 / $1,479.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,380.38 / $2,511.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $45,708.82 / $45,708.82
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,709.64 / $10,232.93 / $10,232.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,479.11 / $2,398.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,348.96 / $2,884.03
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,348.96 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $7,585.78 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,258.93 / $3,090.30