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Maryland rates for HCPCS 63704

Repair Myelomeningocele < 5 Cm Diameter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.03 / $1,720.40 / $2,098.46
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,725.24 / $1,876.36 / $1,988.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,441.75 / $2,066.61 / $3,740.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,779.22 / $2,342.34 / $2,996.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $173.00 / $471.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,266.58 / $1,799.44 / $3,343.78
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.26 / $2,088.14 / $2,505.26