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Montana rates for HCPCS 0627T

Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first level

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.72 / $290.72 / $325.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.67 / $441.67 / $441.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.42 / $397.50 / $441.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.24 / $178.24 / $441.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.42 / $441.67 / $738.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.56 / $438.48 / $483.84