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Montana rates for HCPCS 34843

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 three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,398.83 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,162.28 / $3,630.78
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,162.28 / $3,630.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,884.03 / $3,090.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,778.28 / $3,801.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,884.03 / $4,677.35