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Utah rates for HCPCS 0686T

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

Facilitymedian $6,026 · 10th–90th $3,162–$10,4710%20%10th90th$6,026Professionalmedian $3,715 · 10th–90th $2,754–$4,4670%50%10th90th$3,715$50.0$200.0$1.0K$5.0K$20.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $3,715.35 / $4,073.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25,118.86 / $34,673.69 / $52,480.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,677.35 / $5,888.44
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $3,235.94 / $4,073.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,265.80 / $6,606.93