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Wisconsin 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
$691.83 / $1,122.02 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $18,197.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,659.59 / $2,630.27
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $7,244.36 / $13,489.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $9,772.37 / $16,595.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,380.38 / $2,344.23
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,481.54 / $16,982.44 / $16,982.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $13,803.84 / $17,378.01