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Arizona rates for HCPCS 0264T

Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure excluding bone marrow harvest

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $3,890.45 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $158.49 / $177.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,318.26 / $1,995.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $95.50 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $4,677.35 / $4,677.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $549.54 / $8,128.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $177.83 / $338.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $5,623.41 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $165.96 / $302.00