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Idaho 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
$3,388.44 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,715.35 / $4,365.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,988.33 / $34,673.69 / $57,543.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $5,888.44 / $6,456.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,890.45 / $6,456.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,890.45 / $4,466.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,302.68 / $37,153.52 / $57,543.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,754.40 / $7,585.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $3,235.94 / $43,651.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $4,265.80 / $6,918.31