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Texas 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
$1,000.00 / $3,715.35 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,888.44 / $9,332.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $10,471.29 / $63,095.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $6,606.93 / $8,912.51
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $7,762.47 / $12,589.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $51,286.14
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39,810.72 / $48,977.88 / $48,977.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $6,309.57 / $12,302.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,918.31 / $9,549.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $676.08
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $11,748.98 / $14,125.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $6,918.31 / $13,182.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $7,762.47 / $12,589.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $2,454.71 / $10,232.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $6,606.93 / $10,471.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,754.40 / $5,754.40