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Indiana rates for HCPCS 0072T

Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume greater or equal to 200 cc of tissue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $870.96 / $2,137.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $10,000.00 / $13,182.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,398.83 / $3,715.35
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $8,511.38 / $43,651.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $6,025.60 / $10,715.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,187.76 / $3,548.13