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New Hampshire 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
$100.00 / $2,331.21 / $15,774.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.04 / $628.63 / $2,047.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,667.39 / $5,186.00 / $8,238.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.93 / $864.98 / $3,279.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.44 / $1,493.10 / $5,635.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.40 / $1,908.16 / $5,889.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,399.00 / $12,399.00 / $12,399.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,288.19 / $3,408.76 / $7,362.58
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.24 / $1,435.44 / $2,409.17