go back

Ohio rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,520.03 / $6,085.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.03 / $1,569.12 / $2,901.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,794.51 / $17,502.61 / $31,141.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,201.78 / $1,686.97 / $2,680.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,507.90 / $1,644.98 / $2,395.32
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.43 / $1,774.00 / $2,257.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,616.88 / $2,257.82 / $3,106.15
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.67 / $1,911.67 / $1,911.67
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,644.85 / $2,260.81 / $3,106.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.03 / $1,289.04 / $2,090.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,480.00 / $3,086.00 / $6,111.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,293.00 / $2,006.39 / $3,421.22