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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
$4,466.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,041.74 / $3,890.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $5,888.44 / $7,413.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,019.95 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,187.76 / $2,754.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,511.89 / $4,466.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,090.30 / $3,890.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,235.94 / $3,548.13
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $3,981.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $3,715.35 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,454.71 / $3,311.31