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Washington rates for HCPCS 64415

Injection Aa&/Strd Brachial Plexus W/Img Gdn

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.47 / $1,697.53 / $7,984.74
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,129.00 / $3,129.00 / $3,129.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.44 / $128.99 / $307.39
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.87 / $2,583.03 / $11,500.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,799.32 / $3,874.55 / $7,495.73
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.23 / $217.02 / $1,433.08
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$205.56 / $386.67 / $405.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.83 / $568.48 / $1,132.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.29 / $164.84 / $361.71
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.21 / $163.69 / $840.73
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$976.01 / $2,550.75 / $5,846.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.21 / $161.87 / $491.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.02 / $202.03 / $355.12
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.56 / $219.29 / $269.33
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.76 / $183.71 / $927.31
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.51 / $183.71 / $319.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,674.98 / $2,581.55 / $4,941.05
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,512.46 / $3,872.33 / $7,411.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.52 / $159.16 / $295.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.00 / $938.00 / $4,611.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.68 / $194.31 / $367.43
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.95 / $110.15 / $147.33