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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
$252.12 / $252.12 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.12 / $252.12 / $261.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.45 / $352.45 / $352.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.37 / $426.08 / $717.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.33 / $534.04 / $2,041.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.29 / $387.58 / $448.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.45 / $387.58 / $505.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.42 / $481.99 / $749.76