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Ohio 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
$2,691.53 / $9,549.93 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $158.49 / $190.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,365.16 / $16,982.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $537.03 / $891.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $2,398.83 / $45,708.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $2,630.27 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,379.62 / $21,379.62 / $21,379.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $60.26
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $75.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $6,606.93 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $190.55 / $302.00