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West Virginia 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
$75.20 / $75.20 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.95 / $82.23 / $96.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.97 / $1,175.71 / $2,323.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119,998.80 / $119,998.80 / $119,998.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.96 / $84.96 / $84.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.93 / $353.93 / $353.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.02 / $103.24 / $137.57