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Montana rates for HCPCS 36905

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); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $1,348.96 / $4,265.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $676.08 / $3,548.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $3,630.78 / $4,265.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $3,630.78 / $4,265.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $758.58 / $3,890.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $676.08 / $3,801.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,621.81 / $4,365.16