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Alaska rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,617.84 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,531.86 / $7,628.59 / $7,628.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,932.63 / $5,251.48 / $7,083.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,590.61 / $7,628.59 / $10,680.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,148.45 / $4,978.14 / $10,106.10
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,254.70 / $7,438.50 / $9,662.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,590.61 / $7,628.59 / $10,680.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.71 / $7,426.44 / $11,038.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,201.18 / $6,337.92 / $9,557.68