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Washington, DC 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
$1,614.00 / $6,011.00 / $6,945.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,342.17 / $4,050.55 / $4,050.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,093.27 / $4,308.71 / $4,524.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.23 / $4,089.02 / $12,407.78