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New Hampshire rates for HCPCS 0686T

Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance

Facilitymedian $8,913 · 10th–90th $2,399–$14,7910%10%20%10th90th$8,913Professionalmedian $4,074 · 10th–90th $2,512–$8,7100%10%20%10th90th$4,074$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,388.44 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,715.35 / $4,365.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,912.51 / $10,000.00 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $2,511.89 / $3,548.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,570.88 / $6,456.54 / $10,471.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $5,370.32 / $12,022.64
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,630.78 / $3,981.07 / $5,754.40