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Washington rates for HCPCS 64505

Injection Anes Agent Sphenopalatine Ganglion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.92 / $300.70 / $13,750.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$662.10 / $662.10 / $829.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.76 / $157.91 / $320.97
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$517.23 / $517.23 / $517.23
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.12 / $786.75 / $1,605.58
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$905.78 / $1,259.03 / $2,435.71
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.75 / $284.70 / $1,058.16
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$308.82 / $384.00 / $514.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.26 / $500.00 / $568.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.60 / $206.44 / $405.73
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.72 / $177.38 / $274.70
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$670.80 / $878.49 / $2,113.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.72 / $171.87 / $274.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.60 / $201.32 / $357.49
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $240.35 / $292.79
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.98 / $192.53 / $199.71
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.20 / $256.14 / $355.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.28 / $838.87 / $1,605.58
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$816.42 / $1,258.31 / $2,408.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.87 / $232.32 / $331.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.00 / $546.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.10 / $199.09 / $415.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.26 / $121.19 / $160.83