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Indiana 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)

Facilitymedian $3,802 · 10th–90th $98–$5,6230%10%10th90th$3,802Professionalmedian $78 · 10th–90th $50–$2290%10%20%10th90th$78$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $4,897.79 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $72.44 / $95.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $186.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $190.55 / $338.84
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $1,148.15 / $43,651.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $302.00 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $2,290.87 / $7,413.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $91.20 / $151.36