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Missouri 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
$1,110.00 / $3,232.00 / $8,485.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.96 / $73.04 / $94.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,971.00 / $9,204.00 / $15,746.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.86 / $108.46 / $253.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.40 / $101.40 / $169.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.36 / $100.00 / $932.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $122.88 / $552.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $815.00 / $9,475.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.73 / $116.48 / $178.02