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Indiana rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $3,467.37 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,659.59 / $3,235.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $29,512.09 / $39,810.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,819.70 / $2,951.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,621.81 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $2,398.83 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,949.84 / $3,090.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $5,754.40 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,737.80 / $2,884.03