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Pennsylvania rates for HCPCS 35122

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, hepatic, celiac, renal, or mesenteric artery

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $5,754.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,238.72 / $5,888.44
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,818.38 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,511.89 / $3,801.89
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $3,019.95
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,570.40 / $4,365.16
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,265.80 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,344.23 / $5,754.40
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,398.83 / $4,570.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,290.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,862.09 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,454.71 / $3,890.45