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Montana 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
Professional
Modifier
Low / Median / High Price
$283.14 / $283.14 / $283.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.15 / $441.15 / $441.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.15 / $441.15 / $441.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.15 / $441.15 / $441.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.15 / $496.75 / $584.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.91 / $474.00 / $730.75