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Montana rates for HCPCS 33612

Repair of double outlet right ventricle with intraventricular tunnel repair; with repair of right ventricular outflow tract obstruction

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,228.03 / $10,196.90 / $10,196.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,099.07 / $3,099.07 / $3,099.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,350.17 / $3,099.07 / $3,099.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,099.07 / $3,660.15 / $3,784.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.30 / $2,689.30 / $4,107.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,871.81 / $3,596.63 / $5,429.75