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Pennsylvania rates for HCPCS 0686T

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

Facilitymedian $5,370 · 10th–90th $1,413–$8,5110%10%10th90th$5,370Professionalmedian $3,631 · 10th–90th $2,455–$4,3650%20%10th90th$3,631$200.0$1.0K$5.0K$20.0K

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
$1,412.54 / $5,370.32 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,630.78 / $4,168.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $6,606.93 / $26,302.68
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17,378.01 / $17,378.01 / $17,378.01
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,258.93 / $1,258.93
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,471.29 / $13,182.57 / $16,218.10
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58,884.37 / $58,884.37 / $58,884.37
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $4,265.80 / $8,511.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $3,467.37 / $4,365.16
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30,902.95 / $50,118.72 / $57,543.99
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,311.31 / $4,168.69 / $6,165.95