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Montana 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 $129 · 10th–90th $102–$1320%50%10th90th$129Professionalmedian $79 · 10th–90th $54–$1290%20%10th90th$79$100.0$200.0

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 / $74.13 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $107.15 / $120.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $131.83
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $131.83
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $97.72 / $120.23
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $107.15 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $131.83 / $151.36