go back

Michigan 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
$3,735.91 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,342.17 / $3,735.91 / $4,319.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,189.84 / $22,512.42 / $54,103.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,544.82 / $17,181.12 / $20,453.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,893.14 / $1,893.14 / $1,893.14
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,735.91 / $4,933.00 / $6,333.37
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,515.14 / $3,735.91 / $4,319.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,500.50 / $15,470.64 / $15,470.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,831.58 / $4,689.18 / $6,057.73