go back

Wisconsin 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
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,187.76 / $2,511.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $13,803.84 / $21,877.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,388.44 / $10,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $7,079.46 / $11,481.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $7,585.78 / $8,511.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $7,413.10 / $14,454.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $6,760.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $3,801.89 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $4,265.80 / $12,022.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $4,073.80 / $5,888.44
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $4,570.88 / $22,387.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $8,317.64 / $12,882.50
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,022.64 / $12,022.64 / $12,022.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,481.54 / $16,595.87 / $16,982.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,165.95 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $4,073.80 / $9,772.37