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 four or more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,252.63 | $2,252.63 | $2,252.63 | |
Cigna
| Facility | $3,171.63 | $3,171.63 | $3,171.63 | |
Cigna
| Professional | $3,171.63 | $3,171.63 | $3,171.63 | |
Providence
| Facility | $3,171.63 | $3,171.63 | $3,171.63 | |
Providence
| Professional | $1,638.03 | $2,765.84 | $4,224.50 | |
United
| Professional | $2,404.73 | $3,057.38 | $5,139.26 |