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Montana rates for HCPCS 33987

Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.63 / $1,057.01 / $1,057.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.63 / $318.63 / $318.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.63 / $318.63 / $318.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.49 / $318.63 / $318.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.63 / $318.63 / $318.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.66 / $280.02 / $427.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.08 / $362.40 / $559.63