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Wisconsin rates for HCPCS 64415

Injection Aa&/Strd Brachial Plexus W/Img Gdn

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.63 / $534.47 / $3,452.68
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,397.27 / $3,397.27 / $3,397.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.63 / $127.10 / $918.82
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
$85.08 / $154.87 / $375.79
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$130.33 / $237.42 / $587.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.12 / $79.34 / $100.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.94 / $126.99 / $167.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.55 / $420.16 / $644.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.10 / $269.36 / $599.85
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.63 / $127.10 / $228.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.81 / $143.63 / $2,951.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.34 / $297.82 / $1,433.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.44 / $134.36 / $312.41
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.63 / $127.10 / $228.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.63 / $259.35 / $448.56
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.87 / $314.87 / $982.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.63 / $573.75 / $1,433.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.48 / $403.35 / $790.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,367.00 / $3,088.30 / $4,295.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.97 / $228.20 / $503.14