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Montana rates for HCPCS 64505

Injection Anes Agent Sphenopalatine Ganglion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$987.21 / $987.21 / $987.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.37 / $102.22 / $504.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.68 / $166.68 / $229.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.68 / $166.68 / $166.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.70 / $144.91 / $206.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.84 / $119.15 / $166.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.25 / $174.24 / $270.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.22 / $199.09 / $238.91