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Hawaii 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
$2,570.40 / $6,025.60 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $954.99 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $1,949.84 / $2,344.23
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $724.44 / $2,951.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $1,905.46 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $1,905.46 / $2,630.27
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $467.74 / $2,754.23