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New Hampshire rates for HCPCS 63704

Repair Myelomeningocele < 5 Cm Diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,331.21 / $5,268.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,536.68 / $1,884.19 / $2,315.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,512.20 / $20,162.41 / $35,151.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.38 / $2,857.56 / $4,192.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.67 / $1,911.67 / $1,911.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,043.75 / $2,904.56 / $4,537.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,899.64 / $2,988.51 / $5,863.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,859.09 / $2,443.19 / $4,899.76
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,292.26 / $1,421.49 / $1,809.16