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South Carolina 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
$3,801.89 / $5,888.44 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $257.04 / $302.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $302.00 / $457.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,230.27 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $316.23 / $549.54