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Utah 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
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,290.87 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,884.03 / $3,715.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $12,022.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $4,365.16 / $11,748.98
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $4,570.88 / $6,309.57
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,162.28 / $10,471.29
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
$1,995.26 / $2,570.40 / $4,168.69