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South Dakota rates for HCPCS 64804

Sympathectomy, cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,174.90 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,570.40 / $3,235.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,862.09 / $2,511.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,548.82 / $9,549.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,511.89 / $2,511.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,949.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,778.28 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,819.70 / $2,951.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,754.23 / $2,884.03