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Utah rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,041.74 / $8,709.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,238.72 / $4,466.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $4,570.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,235.94 / $6,456.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $3,548.13 / $5,128.61
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,818.38 / $4,073.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,698.24 / $2,691.53