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Missouri rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,704.00 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,403.33 / $1,679.53 / $2,621.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,232.00 / $6,492.00 / $15,862.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.97 / $1,903.36 / $2,879.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.27 / $2,148.21 / $3,559.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,273.34 / $2,194.05 / $9,475.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,657.74 / $2,569.17 / $11,909.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.00 / $7,904.00 / $11,489.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,551.60 / $2,263.51 / $4,060.23