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Montana rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,137.96 / $5,495.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,089.30 / $2,691.53
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,884.03 / $3,162.28
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,884.03 / $3,162.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,238.72 / $3,162.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,238.72 / $3,467.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,754.23 / $3,162.28