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South Dakota 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
$380.19 / $2,089.30 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $1,659.59 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $5,128.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $2,137.96 / $5,011.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $3,548.13 / $13,182.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $870.96 / $4,265.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $2,454.71 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $1,023.29 / $5,011.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $870.96 / $4,168.69