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Michigan rates for HCPCS 64804

Sympathectomy, cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $1,905.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $2,754.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,754.23 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,318.26 / $3,235.94
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,344.23 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,202.26 / $1,698.24
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,202.26 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,162.28 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,174.90 / $1,621.81