go back

Wisconsin rates for HCPCS 64491

Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 2nd Level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.60 / $1,319.82 / $3,667.44
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$764.80 / $989.86 / $3,505.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.75 / $100.33 / $522.53
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$87.28 / $452.01 / $1,868.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $1,183.00 / $1,530.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.40 / $133.72 / $333.09
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$115.18 / $200.58 / $510.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.30 / $67.56 / $85.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.47 / $92.89 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.52 / $303.27 / $465.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.26 / $228.66 / $433.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.41 / $93.54 / $183.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.62 / $118.31 / $1,455.00
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$969.17 / $969.17 / $1,213.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.21 / $213.26 / $715.99
Medica
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$188.05 / $188.05 / $188.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.91 / $101.24 / $235.87
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.41 / $93.54 / $183.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.25 / $213.68 / $329.39
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.47 / $269.47 / $269.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.99 / $414.81 / $2,750.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.64 / $342.41 / $571.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.98 / $185.60 / $420.38