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Montana rates for HCPCS 64804

Sympathectomy, cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,348.96 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,479.11 / $1,949.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,089.30 / $2,454.71
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,089.30 / $2,454.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,412.54 / $1,995.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,584.89 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,862.09 / $2,238.72