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Virginia rates for HCPCS 34704

Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,786.30 / $12,882.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,848.93 / $37,153.52 / $50,118.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,290.87 / $2,818.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $3,235.94 / $5,128.61
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $3,019.95 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,467.37 / $7,079.46