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Kentucky 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
$56.23 / $1,778.28 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $70.79 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $151.36 / $234.42
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $1,258.93 / $45,708.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,230.27 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $602.56 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $102.33 / $151.36