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Idaho 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
$4,415.00 / $4,500.00 / $8,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.23 / $1,643.84 / $5,628.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.12 / $702.63 / $3,245.56
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.21 / $1,598.51 / $5,965.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.28 / $734.75 / $3,333.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,659.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,303.53 / $13,737.97 / $17,393.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.52 / $727.49 / $3,543.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,800.00 / $17,585.00 / $18,758.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,806.12 / $2,508.46 / $3,811.39