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Montana rates for HCPCS 64804

Sympathectomy Cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,215.39 / $1,546.95 / $5,966.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,919.17 / $1,919.17 / $1,919.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.61 / $1,578.38 / $1,919.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$945.71 / $1,182.14 / $1,507.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.92 / $1,775.91 / $2,487.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,264.68 / $1,912.68 / $2,165.05