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Maryland 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
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,025.60 / $16,218.10
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $6,165.95 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $7,585.78 / $14,791.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $6,456.54 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $6,760.83 / $11,748.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $7,244.36 / $8,511.38