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Pennsylvania rates for HCPCS 35876

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $7,244.36 / $11,220.18
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $5,754.40 / $11,220.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $933.25 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $5,495.41 / $16,982.44