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Pennsylvania 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
$1,020.00 / $4,059.61 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,340.21 / $3,829.50 / $4,866.18
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,969.76 / $5,414.49 / $7,646.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,312.75 / $4,802.18 / $7,007.77
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,120.52 / $5,120.52 / $5,413.25
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,959.10 / $4,046.95 / $7,799.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $6,004.70 / $8,346.70
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,652.65 / $4,811.02 / $7,393.35
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,305.55 / $3,305.55 / $3,922.53
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,154.44 / $3,371.66 / $3,922.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.00 / $2,391.00 / $6,322.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,218.25 / $4,599.72 / $7,485.20