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Michigan 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
$4,897.79 / $4,897.79 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,888.44 / $15,848.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $5,370.32 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,128.31 / $8,511.38 / $9,120.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $7,943.28 / $9,549.93
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $6,918.31 / $18,620.87
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,760.83 / $10,000.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,888.44 / $7,943.28 / $9,549.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,890.45 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,025.60 / $7,079.46 / $10,000.00