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Arkansas 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
$1,181.00 / $1,997.00 / $9,034.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,210.58 / $3,101.87 / $4,187.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.00 / $561.00 / $10,113.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,623.47 / $4,552.58 / $7,033.74