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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
$1,412.54 / $1,584.89 / $1,584.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,584.89 / $2,570.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $2,238.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $2,884.03 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,511.89 / $8,511.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,778.28 / $2,630.27