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West Virginia rates for HCPCS 63704

Repair of myelomeningocele; less than 5 cm diameter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.00 / $1,569.12 / $2,674.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,520.03 / $1,747.50 / $2,418.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,784.67 / $2,070.85 / $2,256.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.97 / $2,005.54 / $2,005.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.67 / $1,911.67 / $1,911.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,616.88 / $2,339.79 / $4,886.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,161.04 / $1,775.24 / $2,642.39