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Pennsylvania rates for HCPCS 64505

Injection, anesthetic agent; sphenopalatine ganglion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.72 / $1,519.00 / $6,012.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.76 / $111.74 / $216.97
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.40 / $1,359.00 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.91 / $148.30 / $227.21
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$214.36 / $222.45 / $340.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.35 / $178.35 / $178.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.75 / $133.86 / $239.64
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.12 / $234.82 / $297.29
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.54 / $1,039.09 / $1,444.38
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,078.42 / $1,078.42 / $1,078.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.00 / $1,978.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.70 / $135.44 / $360.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.44 / $153.00 / $232.91
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.35 / $178.35 / $178.35
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.30 / $135.78 / $241.36
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.45 / $101.09 / $138.71
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.54 / $135.00 / $148.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.18 / $151.24 / $246.72