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Utah 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
$83.18 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $162.18 / $190.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $44.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $7,943.28 / $17,782.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $190.55 / $223.87
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $204.17 / $239.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $186.21 / $309.03