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Montana rates for HCPCS 0686T

Histotripsy Mal Hepatocellular Tiss W/Img Gdn

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,337.96 / $3,713.77 / $6,068.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.86 / $2,922.10 / $5,710.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,252.56 / $1,340.55 / $6,446.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,229.20 / $4,262.89 / $7,486.42