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Illinois rates for HCPCS 63704

Repair Myelomeningocele < 5 Cm Diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.00 / $3,219.12 / $5,549.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,403.33 / $1,811.91 / $3,219.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,893.08 / $23,300.72 / $46,659.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,299.31 / $2,979.29 / $3,284.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,593.06 / $2,538.65 / $3,593.42
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,857.63 / $2,919.53 / $6,711.74
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.76 / $2,232.58 / $2,578.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,915.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.00 / $2,800.00 / $7,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.84 / $2,206.07 / $3,852.48