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Wisconsin 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
$446.68 / $2,344.23 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $1,288.25 / $2,818.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $13,803.84 / $21,877.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $2,290.87 / $7,762.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $5,623.41 / $8,912.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,258.93 / $6,456.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $2,630.27 / $4,786.30
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,230.27 / $5,128.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $8,709.64 / $16,595.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $4,073.80 / $9,772.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,949.84 / $6,025.60
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,489.63 / $13,489.63 / $19,952.62
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $3,715.35 / $12,302.69
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $8,709.64 / $12,589.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $13,803.84 / $17,378.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $1,949.84 / $7,762.47