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Wisconsin rates for HCPCS 64625

Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

Facilitymedian $4,467 · 10th–90th $977–$7,7620%10%10th90th$4,467Professionalmedian $479 · 10th–90th $191–$1,2880%10%10th90th$479$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $446.68 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $416.87 / $707.95
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$478.63 / $478.63 / $478.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $467.74 / $1,071.52
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$426.58 / $707.95 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,513.56 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $812.83 / $2,137.96
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $1,698.24 / $4,786.30
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $602.56 / $1,380.38
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$645.65 / $912.01 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $4,570.88 / $8,317.64
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $1,479.11 / $4,168.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $5,754.40 / $6,025.60
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $707.95 / $2,187.76
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $660.69 / $1,698.24
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $5,248.07
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $1,819.70 / $4,168.69
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $1,698.24
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,548.82 / $2,818.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $707.95 / $1,995.26