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Washington 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
$195.81 / $370.40 / $13,750.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$453.51 / $758.64 / $2,426.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.85 / $175.22 / $351.45
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$220.04 / $800.49 / $993.59
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.29 / $788.95 / $1,605.58
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$905.78 / $1,259.03 / $2,435.71
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.19 / $287.87 / $1,528.92
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$282.52 / $406.13 / $583.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.71 / $500.00 / $568.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.65 / $238.32 / $399.90
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.17 / $221.02 / $339.60
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$670.80 / $878.49 / $2,113.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.17 / $214.76 / $339.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.30 / $151.02 / $268.41
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.72 / $255.94 / $278.72
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.71 / $182.56 / $190.11
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.11 / $274.43 / $343.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.28 / $838.87 / $1,605.58
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$816.42 / $1,258.31 / $2,408.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.88 / $253.90 / $339.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.00 / $546.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.26 / $227.36 / $388.55
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.57 / $130.55 / $152.25