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Wisconsin rates for HCPCS 33884

Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); each additional proximal extension (List separately in addition to code for primary procedure)

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $18,197.01 / $28,840.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,071.52 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,148.15 / $1,288.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $7,762.47 / $14,454.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $954.99 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $3,388.44 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $794.33 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $549.54
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $933.25 / $2,344.23
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $4,570.88 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,982.44 / $17,782.79 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $776.25 / $1,621.81