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Pennsylvania 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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $3,858.88 / $8,247.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $4,761.00 / $8,247.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,135.49 / $3,135.49 / $3,689.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.00 / $2,391.00 / $6,322.00