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Nebraska 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
$5,005.00 / $10,563.53 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,416.05 / $3,432.72 / $4,736.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,533.80 / $2,223.57 / $3,902.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,416.05 / $5,294.88 / $6,832.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,541.77 / $7,380.38 / $10,920.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,092.14 / $16,910.57 / $22,077.69
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,082.80 / $5,082.80 / $5,082.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,625.51 / $16,382.17 / $33,075.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,541.77 / $7,165.31 / $9,462.03