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California rates for HCPCS 64505

Injection, anesthetic agent; sphenopalatine ganglion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.57 / $4,702.00 / $16,125.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$483.29 / $1,317.35 / $2,163.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.37 / $103.87 / $372.20
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$342.40 / $526.22 / $827.00
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$277.45 / $277.45 / $277.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,882.00 / $4,505.00 / $8,976.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.75 / $103.48 / $218.15
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$132.30 / $192.56 / $262.99
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $4,979.42
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.26 / $97.94 / $223.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.69 / $167.99 / $1,487.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.86 / $130.99 / $282.89
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.68 / $120.49 / $209.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.48 / $163.19 / $277.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $485.92 / $526.91
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.00 / $1,030.72 / $1,254.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.03 / $143.56 / $218.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.04 / $142.31 / $297.62
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.02 / $313.02 / $412.80
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.96 / $114.79 / $193.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.00 / $1,523.00 / $5,830.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.50 / $120.58 / $303.10