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California rates for HCPCS 0628T

Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,208.95 / $5,390.00 / $17,013.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.00 / $75.39 / $96.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,108.00 / $7,270.00 / $13,998.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.76 / $342.62 / $565.32
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.80 / $100.00 / $1,638.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.26 / $58.90 / $68.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.32 / $343.65 / $374.35
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.55 / $552.16 / $643.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.67 / $94.57 / $124.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.22 / $68.65 / $340.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.00 / $1,551.00 / $6,323.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.44 / $85.42 / $169.51