go back

Hawaii 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
$1,000.00 / $2,884.03 / $2,884.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $81.28 / $95.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $112.20 / $131.83