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Indiana 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
$1,380.38 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $134.90 / $173.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $398.11 / $933.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $2,454.71 / $43,651.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $181.97 / $316.23