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Arizona rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $3,890.45 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,819.70 / $4,786.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $5,370.32 / $7,943.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,041.74 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,905.46 / $3,235.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,995.26 / $4,466.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,949.84 / $12,022.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,290.87 / $5,495.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,659.59 / $2,951.21