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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
$1,778.28 / $4,897.79 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,737.80 / $4,168.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $7,244.36 / $14,454.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,949.84 / $2,951.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,949.84 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,137.96 / $3,467.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $2,187.76 / $10,232.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,454.71 / $12,022.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,818.38 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,089.30 / $3,388.44