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Arizona rates for HCPCS 39503

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $3,890.45 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,754.40 / $14,125.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $5,370.32 / $7,943.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $6,165.95 / $17,782.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $7,244.36 / $12,589.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $5,623.41 / $10,471.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $6,918.31 / $40,738.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,290.87 / $5,495.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $6,165.95 / $11,481.54