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Iowa 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
$4,227.00 / $5,463.36 / $7,120.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,173.23 / $3,432.72 / $4,109.80
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,432.72 / $5,320.72 / $46,710.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,830.36 / $5,004.77 / $12,412.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,092.14 / $15,721.05 / $18,789.52
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,082.80 / $5,082.80 / $5,082.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,875.68 / $16,875.68 / $25,001.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,830.36 / $4,905.58 / $10,920.01