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Virginia 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
$630.96 / $4,786.30 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $1,479.11 / $2,754.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,918.31 / $8,709.64 / $12,022.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $1,258.93 / $2,754.23
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $7,585.78 / $10,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $1,023.29 / $3,162.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $2,041.74 / $2,511.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $4,570.88 / $4,570.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $1,698.24 / $3,548.13
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $489.78 / $11,481.54
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,454.71 / $11,481.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $12,882.50 / $29,512.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $1,258.93 / $3,548.13