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Wisconsin 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
$2,570.40 / $4,073.80 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,570.40 / $5,128.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $17,378.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,981.07 / $11,481.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $6,025.60 / $9,549.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $6,456.54 / $7,943.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $7,244.36 / $13,489.63
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $5,248.07 / $6,025.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $3,715.35 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $4,466.84 / $15,488.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,019.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $5,011.87 / $8,709.64
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $38,018.94 / $38,018.94
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $10,471.29 / $14,791.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $10,715.19
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,709.64 / $14,125.38 / $14,454.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,165.95 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $4,168.69 / $9,549.93