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Tennessee rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,737.80 / $3,467.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,344.23 / $4,897.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,344.23 / $3,715.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,995.26 / $3,311.31
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $16,982.44 / $16,982.44
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,748.98 / $15,135.61 / $15,135.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,630.27 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,819.70 / $3,162.28