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Wisconsin rates for HCPCS 64495

Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 3+ Level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.82 / $188.99 / $3,452.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.82 / $84.73 / $276.39
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$73.88 / $395.44 / $403.76
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
$64.28 / $117.11 / $290.32
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$100.38 / $175.66 / $445.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.28 / $57.94 / $72.51
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.62 / $85.70 / $112.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.30 / $284.32 / $436.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.78 / $200.43 / $406.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.57 / $87.11 / $169.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.34 / $104.21 / $1,449.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.52 / $191.50 / $667.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.91 / $101.24 / $235.87
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.57 / $87.11 / $169.73
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.68 / $196.18 / $302.41
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.61 / $231.61 / $231.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.12 / $387.28 / $2,504.50
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.11 / $300.12 / $535.14
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
$94.17 / $176.36 / $389.03