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Wisconsin rates for HCPCS 64636

Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.29 / $1,999.78 / $3,964.80
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,369.16 / $3,503.48 / $5,871.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.85 / $219.75 / $1,269.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$81.45 / $258.81 / $975.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $1,183.00 / $1,530.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.20 / $167.09 / $360.97
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$129.30 / $250.63 / $548.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.68 / $66.81 / $84.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.99 / $220.49 / $284.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.11 / $765.55 / $1,174.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.98 / $271.04 / $1,076.10
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.81 / $187.14 / $367.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.03 / $247.77 / $1,695.60
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$774.75 / $1,044.49 / $3,661.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.72 / $364.50 / $1,284.15
Medica
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$816.27 / $816.27 / $816.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.72 / $231.11 / $546.26
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.81 / $181.20 / $367.09
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.24 / $262.99 / $757.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$429.16 / $429.16 / $429.16
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.50 / $570.91 / $1,779.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.72 / $339.70 / $1,418.04
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
$195.96 / $364.50 / $753.97