go back

Pennsylvania rates for HCPCS 35875

Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $5,254.00 / $10,398.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $5,526.00 / $11,083.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.91 / $569.91 / $759.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,304.00 / $4,584.00 / $9,631.00