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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
$1,000.00 / $7,838.38 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,861.66 / $3,682.74 / $4,319.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,393.89 / $4,393.89 / $11,129.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,665.76 / $6,665.76 / $6,665.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $85.00 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,430.17 / $3,730.45 / $4,705.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,252.56 / $6,446.97 / $7,439.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,376.12 / $39,376.12 / $39,376.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,018.80 / $4,262.89 / $8,312.66