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Utah rates for HCPCS 64804

Sympathectomy Cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,161.28 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,161.28 / $1,190.34 / $5,966.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,019.75 / $1,409.58 / $2,621.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.64 / $860.08 / $1,163.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,904.80 / $3,669.11 / $5,334.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,959.26 / $2,244.75 / $2,772.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.31 / $1,195.59 / $2,020.72