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New York 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
$2,454.71 / $5,370.32 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,715.35 / $4,365.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $8,317.64 / $16,595.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $6,606.93 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,378.01 / $17,378.01 / $17,378.01
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,332.54 / $9,332.54 / $9,332.54
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,234.13 / $56,234.13 / $56,234.13
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34,673.69 / $39,810.72 / $48,977.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $4,073.80 / $8,317.64
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,332.54 / $9,332.54 / $9,332.54