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Georgia 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
$1,380.38 / $5,370.32 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $1,288.25 / $2,884.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $4,677.35 / $9,772.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $1,445.44 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $1,122.02 / $3,981.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $1,949.84 / $5,011.87
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $1,584.89 / $3,467.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $7,413.10 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $1,778.28 / $3,981.07