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Maine 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)

Professionalmedian $85 · 10th–90th $54–$1660%20%10th90th$85$50.0$100.0$200.0$500.0

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
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $79.43 / $95.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $275.42 / $389.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $112.20 / $213.80
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $75.86 / $87.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $100.00 / $165.96