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Minnesota 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
$3,630.78 / $3,630.78 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,630.78 / $4,365.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,442.29 / $48,977.88 / $125,892.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $14,454.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,378.01 / $17,378.01 / $17,378.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $10,964.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $5,248.07 / $14,125.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,651.58 / $44,668.36 / $60,255.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $5,128.61 / $11,481.54