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Wisconsin rates for HCPCS 64615

Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.44 / $506.00 / $1,685.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.76 / $229.49 / $770.11
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
$135.72 / $258.23 / $655.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.14 / $140.57 / $181.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.21 / $139.60 / $194.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.98 / $447.54 / $686.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.32 / $367.80 / $646.10
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.72 / $161.32 / $292.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.50 / $203.12 / $1,449.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.01 / $300.38 / $1,066.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.81 / $172.95 / $366.69
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.72 / $159.40 / $292.92
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.57 / $362.85 / $517.13
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.88 / $140.88 / $561.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.70 / $617.99 / $1,104.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.61 / $665.79 / $851.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.00 / $1,370.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.69 / $276.48 / $622.08