go back

Arizona rates for HCPCS 36904

Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $4,521.00 / $7,963.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.73 / $1,813.42 / $2,747.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,805.25 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.58 / $1,185.19 / $1,939.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,477.06 / $6,477.06 / $6,477.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.65 / $922.40 / $2,688.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.22 / $2,000.44 / $8,484.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,655.62 / $2,080.48 / $6,645.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,255.00 / $7,205.00 / $11,396.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.52 / $1,938.05 / $3,292.84