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Louisiana rates for HCPCS 63704

Repair Myelomeningocele < 5 Cm Diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $2,694.00 / $4,050.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,471.88 / $2,498.36 / $2,742.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,261.91 / $10,697.52 / $15,036.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,776.35 / $2,132.34 / $2,852.44
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $1,616.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,628.85 / $2,232.73 / $2,973.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.00 / $1,309.00 / $6,699.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.60 / $1,948.12 / $3,548.50