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Oklahoma 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
$1,392.00 / $4,192.00 / $13,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,615.56 / $3,173.23 / $4,187.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,791.68 / $3,163.91 / $6,238.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,538.21 / $4,476.05 / $8,069.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,970.83 / $14,970.83 / $14,970.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,538.21 / $4,476.05 / $6,379.43