go back

Wisconsin 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
$6,456.54 / $6,456.54 / $17,782.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,943.28 / $12,589.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $3,981.07 / $4,570.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $8,709.64 / $13,803.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $70.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $10,471.29 / $16,982.44