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West 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
$380.19 / $1,412.54 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $1,230.27 / $2,344.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $467.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $616.60 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $1,659.59 / $7,943.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $1,148.15 / $3,090.30