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Maine rates for HCPCS 64804

Sympathectomy, cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $2,511.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,862.09 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,445.44 / $2,630.27
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,778.28 / $3,388.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,479.11 / $4,073.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $2,630.27