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Pennsylvania rates for HCPCS 0071T

Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume less than 200 cc of tissue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $5,754.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,819.70 / $3,162.28
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $660.69 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,079.46 / $7,079.46 / $8,511.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,265.80 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,819.70 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,548.13 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,238.72 / $3,801.89