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Nebraska 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
$2,187.76 / $6,025.60 / $12,589.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $72.44 / $74.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $8,709.64 / $16,982.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $109.65 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $138.04 / $316.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $120.23 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $144.54 / $213.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $128.82 / $316.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $162.18 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $141.25 / $194.98