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Oklahoma rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,630.27 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,621.81 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,995.26 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,089.30 / $2,818.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,905.46 / $5,888.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,819.70 / $12,022.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $1,949.84 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,621.81 / $2,238.72