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Texas 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
$916.00 / $3,596.00 / $12,729.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.50 / $1,499.36 / $2,444.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,755.75 / $7,827.18 / $15,531.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.99 / $1,553.25 / $2,321.69
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.58 / $4,673.06 / $4,673.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,046.75 / $5,046.75 / $5,046.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.24 / $757.04 / $2,832.59
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $2,872.49
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,442.75 / $12,321.44 / $14,523.30
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.21 / $1,417.37 / $2,980.43
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.47 / $2,166.87 / $2,916.94
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.44 / $1,530.23 / $3,211.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.21 / $1,588.09 / $3,530.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.23 / $1,105.19 / $3,176.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,605.00 / $6,608.00 / $13,190.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.53 / $2,006.79 / $3,230.81
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,422.58 / $1,588.09 / $2,261.02