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Montana rates for HCPCS 33871

Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation)

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,495.41 / $5,888.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $5,011.87 / $5,495.41