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Missouri 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
$2,507.00 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,273.77 / $5,685.14 / $11,179.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,500.00 / $12,235.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,169.71 / $6,959.83 / $10,634.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.04 / $8,571.25 / $15,425.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$958.00 / $6,449.82 / $13,758.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,719.83 / $8,500.62 / $41,111.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.00 / $3,233.00 / $11,343.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,625.65 / $7,500.86 / $12,115.24