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Michigan rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $2,884.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,137.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $2,137.96 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,949.84 / $4,466.84
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $4,897.79 / $5,248.07
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,995.26 / $2,754.23
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,659.59 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $3,890.45 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,905.46 / $2,398.83