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Michigan rates for HCPCS 34842

Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,194.08 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.13 / $2,194.08 / $2,275.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,564.34 / $8,966.50 / $20,661.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.70 / $1,717.27 / $2,176.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,196.09 / $2,411.01 / $2,794.10
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,466.71 / $4,933.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,466.71 / $1,634.77 / $2,275.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,713.00 / $3,869.00 / $6,327.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,714.55 / $2,293.25 / $2,985.55