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Virginia rates for HCPCS 33504

Repair of anomalous coronary artery from pulmonary artery origin; by graft, with cardiopulmonary bypass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,636.57 / $4,796.00 / $9,539.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,371.83 / $1,636.57 / $2,334.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,900.00 / $13,875.00 / $15,752.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.83 / $1,679.10 / $2,340.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,763.75 / $1,921.81 / $3,747.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,439.58 / $1,973.13 / $3,329.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.66 / $1,627.99 / $2,007.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,613.62 / $2,028.17 / $2,898.47
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,841.00 / $2,068.00 / $3,334.87
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,422.90 / $1,946.04 / $4,462.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,422.90 / $1,946.04 / $4,462.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,547.00 / $3,130.00 / $5,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.85 / $1,873.75 / $2,925.37