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Wisconsin rates for HCPCS 0686T

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

Facilitymedian $12,303 · 10th–90th $4,467–$20,4170%10%10th90th$12,303Professionalmedian $3,890 · 10th–90th $2,399–$9,3330%20%10th90th$3,890$100.0$500.0$2.0K$10.0K$50.0K

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
$2,290.87 / $2,290.87 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,630.78 / $4,365.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,120.11 / $12,882.50 / $20,417.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,630.78 / $7,244.36 / $18,197.01
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17,378.01 / $17,378.01 / $17,378.01
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,467.37 / $5,128.61
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,715.35 / $10,471.29
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $5,011.87 / $12,589.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26,302.68 / $26,302.68 / $26,302.68
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,128.61 / $9,120.11 / $13,489.63
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $36,307.81 / $53,703.18
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8,317.64 / $28,183.83 / $28,183.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,248.07 / $20,892.96 / $60,255.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,897.79 / $11,748.98