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Utah 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
$522.94 / $3,294.00 / $8,194.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.94 / $2,044.38 / $3,148.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.21 / $2,219.13 / $3,181.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,169.71 / $1,473.12 / $1,983.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,199.25 / $10,837.22 / $15,792.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.30 / $1,060.51 / $3,935.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $9,753.00 / $11,487.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,705.78 / $1,975.91 / $3,303.62