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Montana rates for HCPCS 0686T

Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance

Facilitymedian $4,266 · 10th–90th $1,047–$7,2440%10%10th90th$4,266Professionalmedian $3,715 · 10th–90th $2,512–$4,3650%20%10th90th$3,715$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,715.35 / $4,073.80
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38,018.94 / $38,018.94 / $38,018.94
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38,018.94 / $38,018.94 / $38,018.94
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $4,168.69 / $6,606.93
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,348.96 / $7,413.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $4,265.80 / $6,918.31