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Idaho 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
$1,407.00 / $4,500.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.90 / $74.87 / $81.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.90 / $76.89 / $101.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $55.00 / $3,900.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.99 / $112.93 / $118.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $1,800.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.26 / $118.61 / $158.88