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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
$831.76 / $5,754.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $151.36 / $173.78
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $4,265.80 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $151.36 / $177.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $13,489.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $186.21 / $295.12