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Indiana rates for HCPCS 0686T

Histotripsy Mal Hepatocellular Tiss W/Img Gdn

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,386.00 / $3,500.00 / $14,063.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,342.17 / $3,101.87 / $4,109.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,683.00 / $11,305.00 / $30,091.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,147.35 / $1,434.20 / $1,979.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,955.18 / $55,671.13 / $94,313.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.00 / $4,393.89 / $12,590.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,893.14 / $1,893.14 / $1,893.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,657.16 / $16,657.16 / $17,298.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,538.21 / $4,262.89 / $6,700.92