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North Carolina 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
$74.70 / $1,615.00 / $7,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.95 / $74.70 / $86.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.65 / $149.54 / $219.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.20 / $74.17 / $92.92
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.20 / $72.20 / $96.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.60 / $101.60 / $101.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.00 / $896.00 / $2,229.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.63 / $108.03 / $190.73
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.97 / $189.11 / $374.35
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.55 / $643.95 / $643.95