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Minnesota 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
$251.19 / $251.19 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $263.03 / $331.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,122.02 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $562.34 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $549.54 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,862.09 / $3,715.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $467.74 / $1,023.29