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Wisconsin rates for HCPCS 64616

Chemodenervation Muscle Neck Unilat For Dystonia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.30 / $213.03 / $1,894.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$561.67 / $561.67 / $1,432.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.50 / $129.78 / $553.03
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$168.66 / $783.00 / $1,593.75
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
$118.70 / $228.79 / $568.98
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$183.00 / $346.42 / $877.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.58 / $125.50 / $161.40
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.30 / $127.54 / $175.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.63 / $408.58 / $626.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.79 / $358.48 / $587.29
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.26 / $144.28 / $266.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.33 / $180.95 / $1,449.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.75 / $255.40 / $947.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.89 / $167.11 / $352.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.26 / $143.90 / $266.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.64 / $330.51 / $471.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.22 / $142.22 / $504.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.47 / $561.74 / $1,000.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.46 / $600.11 / $773.87
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
$139.41 / $234.36 / $538.13