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South Carolina 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
$504.57 / $7,799.00 / $16,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.07 / $1,643.84 / $2,457.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$341.96 / $706.14 / $2,305.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.23 / $930.00 / $2,058.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,473.43 / $4,473.43 / $5,748.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.32 / $1,035.58 / $3,423.42
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.88 / $1,895.99 / $3,652.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,070.40 / $3,957.93 / $4,656.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,523.32 / $1,936.40 / $2,898.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $19,627.00 / $25,620.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.21 / $2,328.60 / $4,475.32