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New Mexico 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
$2,041.74 / $7,762.47 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,715.35 / $4,365.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,234.13 / $69,183.10 / $81,283.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $11,220.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,378.01 / $17,378.01 / $17,378.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $60.26 / $85.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $3,801.89 / $6,456.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $6,456.54 / $17,378.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,884.42 / $74,131.02 / $74,131.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $4,265.80 / $6,760.83