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Minnesota 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
$72.44 / $72.44 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $72.44 / $85.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $588.84 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $141.25 / $354.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $123.03 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $141.25 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,862.09 / $3,467.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $123.03 / $251.19