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Missouri 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
$1,895.99 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.50 / $1,643.84 / $2,265.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,490.00 / $12,991.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.84 / $1,276.31 / $2,722.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.30 / $878.35 / $3,936.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.36 / $2,182.17 / $11,076.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,975.91 / $3,658.44 / $13,077.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,426.00 / $4,859.00 / $15,920.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.96 / $2,404.42 / $4,250.01