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New Hampshire rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $5,248.07 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,862.09 / $3,890.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $21,877.62 / $34,673.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $3,388.44 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,754.23 / $4,786.30
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,818.38 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,344.23 / $4,466.84
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,995.26