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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
$2,290.87 / $4,466.84 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,630.78 / $4,365.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,548.82 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $4,168.69 / $7,585.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $4,466.84 / $7,244.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $16,218.10 / $22,908.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $4,466.84 / $6,309.57