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North Dakota 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
$2,546.15 / $2,546.15 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,546.15 / $3,493.25 / $3,735.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,210.23 / $3,580.50 / $6,474.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,613.94 / $6,276.87 / $10,016.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,538.73 / $5,288.70 / $10,016.75