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Idaho 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
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.60 / $172.46 / $189.30
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.60 / $172.46 / $220.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $3,900.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,370.62 / $11,210.07 / $14,021.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.27 / $245.27 / $258.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,120.00 / $22,317.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.40 / $207.37 / $318.20