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Arizona 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
$1,965.00 / $4,474.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,515.14 / $3,761.53 / $6,068.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.86 / $2,613.12 / $4,578.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.59 / $977.69 / $1,099.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,988.13 / $10,563.14 / $17,307.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.56 / $3,944.88 / $7,100.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,002.76 / $4,262.89 / $7,669.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,500.50 / $16,976.38 / $16,976.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,002.76 / $4,262.89 / $6,165.87