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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
$1,493.11 / $1,539.29 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.74 / $1,520.03 / $1,866.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,778.00 / $23,175.52 / $32,252.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.14 / $1,820.70 / $2,512.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,455.92 / $1,892.70 / $2,183.88
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.92 / $1,747.10 / $2,183.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,424.43 / $1,985.59 / $3,150.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,062.00 / $5,167.00 / $10,396.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.94 / $1,720.86 / $2,973.79