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Missouri 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
$2,297.00 / $4,908.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,342.17 / $3,579.65 / $4,573.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.49 / $1,455.88 / $1,883.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,530.00 / $2,530.00 / $2,530.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,391.87 / $4,276.55 / $7,360.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,703.27 / $4,718.30 / $8,830.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,125.53 / $15,626.45 / $22,750.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,703.27 / $4,689.18 / $7,768.59