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Utah 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
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,548.13 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,235.94 / $3,630.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $6,918.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $5,011.87 / $6,606.93
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $5,011.87 / $7,079.46
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $3,388.44 / $5,011.87
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
$2,238.72 / $2,818.38 / $4,677.35