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Alaska 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
$2,344.23 / $10,000.00 / $16,982.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,715.35 / $4,466.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $4,466.84 / $6,606.93
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,890.45 / $4,786.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,466.84 / $6,606.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $8,128.31 / $13,803.84