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Kansas 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
$1,348.96 / $3,801.89 / $8,128.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $72.44 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $97.72 / $1,288.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $102.33 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $537.03 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $97.72 / $131.83