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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)

Facilitymedian $3,388 · 10th–90th $380–$9,7720%5%10%10th90th$3,388Professionalmedian $79 · 10th–90th $47–$2340%10%10th90th$79$50.0$200.0$1.0K$5.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $2,818.38 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $72.44 / $95.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,918.31 / $10,471.29 / $16,218.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $109.65 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $169.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $109.65 / $1,258.93
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $117.49 / $549.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $707.95 / $5,011.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $100.00 / $151.36