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South Dakota 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 / $2,290.87 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $263.03 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $407.38 / $812.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $416.87 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $436.52 / $741.31