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Montana 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
Professional
Modifier
Low / Median / High Price
$102.33 / $158.49 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $257.04
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $12,589.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $12,589.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $194.98 / $204.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $257.04 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $251.19 / $380.19