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New Mexico rates for HCPCS 63704

Repair Myelomeningocele < 5 Cm Diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $2,095.00 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.43 / $1,566.92 / $7,459.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,490.42 / $2,389.71 / $3,064.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,693.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,515.88 / $1,960.00 / $2,418.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,593.14 / $2,540.32 / $4,125.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,085.00 / $5,089.00 / $17,636.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,676.70 / $2,383.21 / $3,361.80