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Pennsylvania rates for HCPCS 64605

Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $2,127.73 / $6,012.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.82 / $552.50 / $785.78
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.27 / $899.14 / $1,365.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.87 / $724.87 / $724.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.78 / $647.53 / $1,185.06
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.78 / $1,448.09 / $1,825.35
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,600.68 / $4,600.68 / $4,600.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $2,127.73 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.82 / $618.99 / $1,832.79
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.10 / $426.20 / $1,355.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.87 / $724.87 / $724.87
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.15 / $659.16 / $1,284.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.42 / $343.45 / $626.74
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.28 / $456.33 / $673.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.28 / $777.42 / $1,233.58