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Massachusetts 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 / $3,061.00 / $5,011.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,827.93 / $4,050.55 / $4,464.42
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,792.60 / $53,287.10 / $53,287.10
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,980.64 / $5,619.72 / $27,944.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.00 / $748.00 / $20,912.31
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,271.67 / $5,271.67 / $6,201.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27,751.11 / $35,001.40 / $43,951.76
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,792.60 / $53,287.10 / $53,287.10
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,989.00 / $5,619.72 / $27,944.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,782.36 / $5,289.91 / $10,225.54