Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally to the iliac bifurcation, and treatment zone angioplasty/stenting, when performed, unilateral; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, traumatic disruption)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,627.00 | $7,920.26 | $11,029.52 | |
Kaiser Permanente
| Professional | $2,746.80 | $3,858.49 | $4,392.38 | |
Moda Health
| Facility | $1,673.28 | $3,379.58 | $5,081.18 | |
Pacific Source
| Facility | $2,220.67 | $3,346.10 | $3,611.97 | |
Providence
| Facility | $1,673.28 | $3,685.63 | $5,081.18 | |
United
| Facility | $2,364.00 | $7,664.00 | $36,803.00 |