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California rates for HCPCS 64612

Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.00 / $4,344.83 / $16,109.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$695.56 / $4,296.00 / $8,245.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.83 / $157.80 / $613.49
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$217.52 / $597.48 / $993.59
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$100.63 / $263.95 / $344.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,723.00 / $4,464.00 / $8,976.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.47 / $235.62 / $411.22
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$168.50 / $212.22 / $263.97
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $4,979.42
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.93 / $179.90 / $369.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.63 / $155.91 / $1,487.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.02 / $176.75 / $334.33
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.40 / $141.01 / $199.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.79 / $167.68 / $289.66
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $559.12 / $605.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,415.00 / $1,528.92 / $1,721.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.22 / $178.34 / $266.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.94 / $188.10 / $335.92
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.65 / $380.65 / $437.15
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.84 / $144.78 / $184.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.00 / $1,523.00 / $5,830.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.56 / $160.44 / $303.97