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South Carolina rates for HCPCS 64804

Sympathectomy, cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $7,943.28 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $2,089.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,073.80 / $7,762.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,412.54 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,412.54 / $2,570.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,754.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,380.38 / $2,454.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $6,760.83 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,122.02 / $1,862.09