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Maine rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,862.09 / $4,168.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,703.96 / $26,915.35 / $36,307.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,570.40 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,290.87 / $3,630.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,454.71 / $4,677.35
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,137.96 / $5,623.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,137.96 / $3,630.78