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Tennessee rates for HCPCS 63704

Repair Myelomeningocele < 5 Cm Diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,962.39 / $3,499.95 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,403.33 / $1,688.14 / $2,418.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $2,302.00 / $4,528.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,498.01 / $2,032.04 / $3,205.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,593.06 / $2,090.42 / $3,314.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $17,036.37 / $17,431.02
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,647.36 / $11,909.60 / $15,060.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,233.00 / $2,665.00 / $4,918.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.97 / $1,975.27 / $3,443.47