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North Carolina 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
$1,635.00 / $7,439.00 / $10,561.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,827.93 / $3,568.37 / $4,074.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.76 / $75.00 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.65 / $9,652.90 / $18,210.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,665.76 / $6,665.76 / $6,665.76
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,309.52 / $3,568.37 / $4,705.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,981.33 / $15,264.83 / $18,250.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,713.08 / $4,538.20 / $7,797.74
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,792.60 / $53,287.10 / $53,287.10
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27,944.72 / $33,483.08 / $33,483.08