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Idaho rates for HCPCS 64804

Sympathectomy, cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,202.26 / $2,754.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $3,090.30 / $5,495.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,187.76 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,548.82 / $1,995.26
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,548.82 / $3,162.28
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,137.96 / $2,754.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,365.16 / $6,309.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,290.87 / $2,570.40
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,288.25 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $3,467.37 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,479.11 / $2,290.87