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Maryland rates for HCPCS 0686T

Histotripsy Mal Hepatocellular Tiss W/Img Gdn

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,515.14 / $3,817.70 / $4,187.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.00 / $8,869.69 / $12,604.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,893.14 / $1,893.14 / $6,665.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,662.40 / $4,653.41 / $6,156.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,343.63 / $4,097.05 / $9,092.20