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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
$346.74 / $2,570.40 / $8,317.64
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $128.82 / $302.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$524.81 / $575.44 / $831.76
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,230.27 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $147.91 / $218.78
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$213.80 / $223.87 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $134.90 / $239.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $245.47 / $309.03
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $169.82 / $251.19
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $1,000.00 / $1,445.44
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $2,089.30 / $7,762.47
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $151.36 / $363.08
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$436.52 / $562.34 / $831.76
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $295.12
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $162.18 / $288.40
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $138.04 / $549.54
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $138.04 / $354.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $831.76 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $125.89 / $204.17