go back

New Hampshire 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
$100.00 / $2,331.21 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,625.89 / $3,839.56 / $4,464.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,512.20 / $9,458.00 / $17,300.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.66 / $2,334.00 / $3,301.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,496.02 / $42,854.21 / $60,146.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,188.07 / $5,202.47 / $12,996.73
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00