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Washington 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
$3,354.00 / $12,900.00 / $23,717.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.00 / $1,950.00 / $4,217.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,048.63 / $10,558.66 / $19,848.13
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $100.00 / $670.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.97 / $765.00 / $870.49
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,135.43 / $13,013.18 / $31,309.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,597.54 / $3,305.12 / $3,523.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,975.14 / $10,360.75 / $19,669.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,129.00 / $11,941.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.44 / $317.44 / $317.44