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West Virginia rates for HCPCS 0686T

Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.00 / $2,300.00 / $3,713.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,827.93 / $3,682.74 / $4,074.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,940.70 / $61,108.84 / $125,678.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119,998.80 / $119,998.80 / $119,998.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,393.89 / $4,393.89 / $4,393.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,665.76 / $6,665.76 / $6,665.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,865.97 / $3,979.55 / $7,127.84