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Wisconsin rates for HCPCS 64400

Injection Aa&/Strd Trigeminal Nerve Each Branch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.56 / $324.87 / $1,241.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.32 / $103.24 / $318.31
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$144.80 / $830.88 / $927.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $2,479.00 / $4,441.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.45 / $130.04 / $328.02
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$105.70 / $195.06 / $492.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.25 / $59.10 / $75.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.43 / $104.40 / $138.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.07 / $350.66 / $537.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.61 / $210.31 / $497.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.39 / $101.11 / $185.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.99 / $121.33 / $1,368.00
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$595.35 / $595.35 / $654.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.06 / $258.19 / $1,030.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.91 / $110.23 / $235.87
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.07 / $101.11 / $185.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.74 / $219.05 / $378.86
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.19 / $160.19 / $237.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.59 / $475.43 / $1,030.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.68 / $376.86 / $654.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,590.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.57 / $219.92 / $461.02