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South Dakota 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
$158.49 / $158.49 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $158.49 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $275.42 / $338.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $229.09 / $416.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $263.03 / $1,202.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $338.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $245.47 / $407.38