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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
$1,096.48 / $2,691.53 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $4,265.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $4,265.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,467.37 / $3,548.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,905.46 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,818.38 / $4,786.30