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Arkansas rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,862.09 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,778.28 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,290.87 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $1,071.52 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,819.70 / $2,951.21