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Washington rates for HCPCS 64636

Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.37 / $590.33 / $7,984.74
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$980.98 / $1,775.25 / $3,085.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.81 / $177.67 / $673.28
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$81.45 / $185.91 / $663.13
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.53 / $105.54 / $466.64
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$84.80 / $84.80 / $158.31
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $429.16 / $1,700.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,469.92 / $2,469.92 / $2,469.92
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.79 / $420.59 / $1,779.12
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$142.69 / $669.30 / $690.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $714.97 / $870.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.22 / $189.53 / $682.65
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.94 / $160.32 / $441.32
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,908.48 / $1,908.48 / $1,908.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.11 / $160.32 / $448.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.90 / $352.15 / $629.43
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.60 / $350.88 / $482.40
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.04 / $329.04 / $335.67
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.64 / $193.47 / $575.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,307.00 / $1,307.00 / $1,646.62
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,960.50 / $1,960.50 / $2,469.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.70 / $190.09 / $544.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.00 / $546.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.57 / $316.36 / $688.74
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.39 / $193.25 / $268.17