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Wisconsin rates for HCPCS 64505

Injection, anesthetic agent; sphenopalatine ganglion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $208.93 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $138.04 / $338.84
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$309.03 / $562.34 / $831.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $194.98 / $457.09
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$169.82 / $288.40 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $436.52 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $371.54 / $645.65
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $151.36 / $3,162.28
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $275.42 / $380.19
DeanCare
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$281.84 / $407.38 / $562.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $165.96 / $1,513.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $239.88 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $112.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $323.59 / $489.78
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $331.13 / $1,288.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $602.56 / $1,023.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $588.84 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,548.82 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $165.96 / $446.68