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Maryland 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
Professional
Modifier
Low / Median / High Price
$50.12 / $75.86 / $87.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $89.13 / $134.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $40.74 / $128.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $91.20 / $162.18