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Maine rates for HCPCS 63704

Repair Myelomeningocele < 5 Cm Diameter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.74 / $1,536.68 / $1,884.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,744.96 / $31,420.90 / $36,545.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.38 / $2,093.83 / $3,361.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,775.83 / $2,502.69 / $3,510.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,114.59 / $2,446.58 / $3,753.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.74 / $1,884.19 / $2,250.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,543.09 / $2,201.96 / $3,263.22