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Michigan 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
$162.18 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $154.88 / $173.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,365.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,365.16 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $288.40
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $436.52 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $165.96 / $323.59
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $7,244.36 / $11,481.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $194.98 / $269.15