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Indiana 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
$2,344.23 / $4,897.79 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,754.40 / $7,413.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $25,118.86 / $31,622.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $4,677.35 / $7,413.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,495.41 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $7,943.28 / $12,589.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $6,760.83 / $12,302.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $5,754.40 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $6,309.57 / $10,232.93