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Hawaii 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
$1,924.00 / $5,484.00 / $6,718.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,101.87 / $3,643.73 / $4,464.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.28 / $3,996.85 / $5,195.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,356.97 / $4,655.26 / $5,995.28