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Montana rates for HCPCS 33853

Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; with cardiopulmonary bypass

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,784.03 / $2,040.25 / $9,350.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,847.73 / $2,847.73 / $2,847.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,139.86 / $2,847.73 / $2,847.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,847.73 / $3,569.83 / $3,618.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,741.08 / $2,466.57 / $3,767.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,492.87 / $3,182.40 / $4,983.89