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Utah rates for HCPCS 63704

Repair Myelomeningocele < 5 Cm Diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,301.04 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,664.35 / $2,301.04 / $8,335.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,676.40 / $2,237.88 / $4,619.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.34 / $1,061.39 / $1,585.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,728.53 / $3,138.96 / $4,115.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,312.00 / $2,446.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.10 / $1,719.72 / $2,700.47