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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
$1,671.00 / $3,819.00 / $6,329.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.35 / $1,525.92 / $5,164.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,506.06 / $1,721.22 / $2,151.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,397.00 / $1,922.93 / $3,063.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,495.87 / $1,919.83 / $4,276.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,374.79 / $1,724.70 / $11,909.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,519.00 / $3,269.00 / $5,491.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,312.20 / $1,647.75 / $3,316.64