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Ohio 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
$3,444.00 / $7,342.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,515.14 / $3,682.74 / $4,319.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,425.00 / $4,313.00 / $25,522.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,251.17 / $1,636.83 / $2,433.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,756.05 / $50,264.76 / $91,553.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,225.55 / $63,383.31 / $111,852.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $11,330.88 / $19,115.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,665.76 / $6,665.76 / $6,665.76
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $11,330.88 / $14,240.39
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,665.76 / $6,665.76 / $6,665.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,494.11 / $14,858.47 / $15,893.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,376.58 / $4,453.09 / $6,719.44