go back

Pennsylvania rates for HCPCS 64804

Sympathectomy Cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,095.24 / $2,747.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$924.94 / $1,098.47 / $1,474.21
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,205.54 / $1,251.03 / $2,043.03
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
$901.73 / $1,312.31 / $2,308.69
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,447.82 / $2,037.89 / $2,500.78
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,761.00 / $8,427.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,024.28 / $1,230.32 / $5,958.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.80 / $1,160.80 / $2,419.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,366.34 / $1,366.34 / $1,366.34
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.91 / $1,335.89 / $2,308.69
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.84 / $1,172.84 / $1,219.68
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,117.93 / $1,196.31 / $1,248.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.00 / $2,956.46 / $6,368.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,012.94 / $1,375.61 / $2,121.42