go back

Montana rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,700.41 / $2,161.48 / $8,335.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,683.68 / $2,683.68 / $2,683.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,395.89 / $2,509.58 / $2,683.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,322.24 / $1,722.29 / $2,683.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.80 / $2,509.58 / $3,479.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,245.17 / $2,676.31 / $3,057.27