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Michigan rates for HCPCS 64804

Sympathectomy Cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,559.66 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.11 / $1,470.88 / $1,619.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,880.27 / $2,206.88 / $2,989.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.61 / $1,735.74 / $3,096.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.67 / $1,329.84 / $2,565.27
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.20 / $1,559.66 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.20 / $1,207.49 / $1,856.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.71 / $1,006.77 / $1,554.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $3,394.45 / $6,307.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.83 / $1,152.33 / $1,615.16