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Wisconsin rates for HCPCS 64400

Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular)

Facilitymedian $2,239 · 10th–90th $120$4,6770%10%10th90th$2,239Professionalmedian $138 · 10th–90th $51$4170%5%10th90th$138$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $331.13 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $114.82 / $316.23
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$144.54 / $346.74 / $933.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $128.82 / $295.12
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$104.71 / $194.98 / $436.52
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $64.57 / $85.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $346.74 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $194.98 / $512.86
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $125.89 / $3,162.28
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $194.98 / $302.00
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$138.04 / $295.12 / $457.09
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $154.88 / $1,513.56
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$588.84 / $588.84 / $660.69
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $229.09 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $89.13
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $213.80 / $562.34
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $194.98 / $407.38
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $346.74 / $1,288.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $512.86 / $1,023.29
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $398.11
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $380.19 / $660.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,584.89 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $138.04 / $426.58