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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);

Facilitymedian $6,026 · 10th–90th $2,512–$11,2200%10%10th90th$6,026Professionalmedian $1,950 · 10th–90th $380–$4,0740%10%10th90th$1,950$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $4,570.88 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $1,949.84 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $616.60 / $3,162.28
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $851.14 / $8,128.31
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,128.31 / $11,220.18 / $16,982.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $1,071.52 / $5,011.87
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $1,621.81 / $4,570.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $2,344.23 / $6,606.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $5,128.61 / $11,748.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $1,584.89 / $3,467.37