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Utah rates for HCPCS 64804

Sympathectomy, cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,230.27 / $6,309.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,348.96 / $2,630.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,995.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,388.44 / $7,585.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,290.87 / $3,090.30
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,995.26 / $2,884.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,905.46 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,174.90 / $1,778.28