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Montana rates for HCPCS 35612

Bypass graft, with other than vein; subclavian-subclavian

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $3,467.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,621.81
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,778.28 / $1,949.84
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,778.28 / $1,949.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,621.81 / $1,778.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,000.00 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,778.28 / $2,818.38