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Pennsylvania 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
$150.96 / $3,839.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.00 / $128.07 / $179.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.00 / $148.56 / $700.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,914.00 / $7,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.44 / $196.06 / $318.17