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Idaho rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.66 / $2,301.04 / $3,856.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,759.61 / $2,346.14 / $2,786.04
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,581.37 / $2,898.90 / $4,435.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,737.98 / $2,986.88 / $3,736.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $2,231.78 / $2,807.73
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,891.55 / $3,401.82 / $3,736.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.00 / $3,700.00 / $26,104.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.32 / $2,514.71 / $3,527.44