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Wisconsin rates for HCPCS 64635

Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.83 / $1,894.00 / $6,693.73
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,826.84 / $4,477.28 / $8,514.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.23 / $425.91 / $2,519.67
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$272.05 / $1,090.94 / $4,462.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.00 / $3,496.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.13 / $435.29 / $1,115.00
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$421.69 / $652.92 / $1,672.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.73 / $216.88 / $271.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.98 / $411.58 / $535.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,196.69 / $1,398.42 / $2,145.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.91 / $852.79 / $1,978.35
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.23 / $416.25 / $793.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.96 / $487.01 / $6,955.00
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,512.90 / $6,616.80 / $8,232.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.80 / $883.71 / $3,113.32
Medica
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$2,235.63 / $2,235.63 / $2,235.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.95 / $308.15 / $852.65
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.23 / $416.25 / $793.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.08 / $845.00 / $1,461.46
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.34 / $1,127.34 / $1,900.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.42 / $1,659.61 / $3,287.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.76 / $1,123.72 / $2,606.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,103.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.78 / $807.04 / $1,842.07