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New Hampshire rates for HCPCS 64804

Sympathectomy Cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,331.21 / $3,229.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.37 / $1,183.51 / $1,654.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,186.79 / $2,034.49 / $2,998.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,366.34 / $1,366.34 / $1,366.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,449.42 / $2,010.00 / $3,245.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,358.63 / $2,228.96 / $4,193.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,611.00 / $8,611.00 / $8,611.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.92 / $1,809.95 / $3,514.77
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$924.63 / $1,017.09 / $1,294.48