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Utah rates for HCPCS 33500

Repair of coronary arteriovenous or arteriocardiac chamber fistula; with cardiopulmonary bypass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,737.80 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,238.72 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $9,120.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $3,388.44 / $8,912.51
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $3,630.78 / $4,897.79
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,454.71 / $7,943.28
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
$1,548.82 / $1,995.26 / $3,235.94