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Montana rates for HCPCS 0265T

Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; unilateral or bilateral bone marrow harvest only for intramuscular autologous bone marrow cell therapy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $257.04 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $398.11 / $436.52
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $12,589.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $12,589.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $269.15 / $467.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $398.11 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $467.74 / $575.44