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Maine rates for HCPCS 64505

Injection, anesthetic agent; sphenopalatine ganglion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.28 / $144.28 / $199.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.17 / $103.87 / $147.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.83 / $129.68 / $191.56
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$155.74 / $181.21 / $287.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.66 / $179.11 / $284.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.32 / $180.96 / $321.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.28 / $144.28 / $199.99
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.17 / $111.74 / $199.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.14 / $160.02 / $290.25