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Michigan rates for HCPCS 33622

Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2, Norwood, bidirectional Glenn, pulmonary artery debanding)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,561.04 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,350.52 / $4,561.04 / $4,729.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,389.37 / $20,267.91 / $27,459.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.53 / $4,774.35 / $6,784.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,039.28 / $5,224.71 / $6,543.20
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,823.35 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,724.94 / $3,886.89 / $4,990.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.09 / $2,711.51 / $4,236.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.00 / $4,645.00 / $6,740.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,955.17 / $4,995.18 / $6,704.10