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South Dakota 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
$1,770.02 / $1,770.02 / $1,770.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,627.84 / $1,770.02 / $1,770.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,035.60 / $4,440.87 / $5,551.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,217.14 / $2,338.39 / $4,262.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,942.26 / $3,531.38 / $12,087.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,658.74 / $4,006.98 / $5,182.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,993.08 / $4,159.22 / $5,182.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,942.26 / $3,149.84 / $3,818.42