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Montana rates for HCPCS 34845

Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,947.67 / $1,947.67 / $1,947.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.05 / $2,905.05 / $2,905.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,905.05 / $2,905.05 / $2,905.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.05 / $2,905.05 / $2,905.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,365.03 / $2,391.41 / $3,652.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.97 / $2,576.14 / $4,425.10