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Florida 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
$1,924.00 / $6,024.00 / $11,624.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,337.96 / $3,770.05 / $4,319.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.32 / $9,234.65 / $10,473.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,665.76 / $6,665.76 / $6,665.76
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,154.29 / $6,780.00 / $15,300.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,500.50 / $22,500.90 / $63,283.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,246.57 / $3,688.78 / $5,836.46
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.66 / $1,409.66 / $1,409.66