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Idaho 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
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,233.56 / $5,697.48 / $7,290.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,911.58 / $9,684.83 / $10,812.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,233.56 / $7,290.95 / $11,509.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,141.51 / $9,695.54 / $11,080.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $7,702.97 / $9,690.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,746.65 / $8,746.65 / $10,445.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,700.00 / $15,298.00 / $26,104.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,250.72 / $8,185.69 / $12,816.80