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Michigan rates for HCPCS 0717T

Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; adipose tissue harvesting, isolation and preparation of harvested cells, including incubation with cell dissociation enzymes, filtration, washing and concentration of ADRCs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,112.00 / $4,112.00 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,423.01 / $3,423.01 / $3,423.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,251.86 / $3,594.16 / $4,278.76
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,112.00 / $4,933.00 / $5,756.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,500.00 / $7,780.00 / $9,202.00