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Wisconsin rates for HCPCS 64630

Dstrj Neurolytic Agent Pudendal Nerve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.12 / $392.13 / $3,119.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.12 / $244.67 / $938.42
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
$220.61 / $369.56 / $1,086.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.24 / $785.56 / $1,205.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.99 / $660.80 / $1,127.08
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.12 / $259.44 / $435.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.87 / $280.82 / $2,951.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.41 / $512.50 / $1,898.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.93 / $273.68 / $586.37
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.12 / $259.44 / $435.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.46 / $597.76 / $871.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$892.96 / $892.96 / $982.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.62 / $1,078.02 / $1,898.16
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.13 / $663.13 / $907.42
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.79 / $1,096.10 / $1,485.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,957.00 / $3,068.00 / $4,295.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.94 / $429.71 / $1,060.10