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Montana rates for HCPCS 34847

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,312.73 / $2,312.73 / $2,312.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,481.32 / $3,481.32 / $3,481.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,481.32 / $3,481.32 / $3,481.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,481.32 / $3,481.32 / $3,481.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,419.62 / $2,696.18 / $4,118.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,340.06 / $2,852.16 / $4,752.74