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Indiana rates for HCPCS 0481T

Injection(s), autologous white blood cell concentrate (autologous protein solution), any site, including image guidance, harvesting and preparation, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.25 / $3,500.00 / $5,634.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.72 / $175.25 / $255.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.00 / $4,320.00 / $8,230.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.84 / $173.66 / $239.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.95 / $4,214.18 / $6,700.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.85 / $229.23 / $229.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.41 / $318.01 / $550.79