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Pennsylvania 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
$831.76 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $263.03 / $316.23
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,344.23 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $263.03 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $1,071.52 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $331.13 / $549.54