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Utah 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
Facility
Modifier
Low / Median / High Price
$1,096.48 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,344.23 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,019.95 / $4,073.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $4,073.80 / $5,495.41
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,949.84 / $2,041.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $3,467.37 / $3,630.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,290.87 / $3,548.13