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Montana rates for HCPCS 35103

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, hypogastric, external)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,951.21 / $7,585.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $3,388.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,801.89 / $4,168.69
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,801.89 / $4,168.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,548.13 / $4,265.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,089.30 / $4,073.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,801.89 / $6,025.60