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South Dakota 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
$72.44 / $2,290.87 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $72.44 / $81.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $123.03 / $194.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $114.82 / $549.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $114.82 / $213.80