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Indiana rates for HCPCS 0629T

Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; first level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.66 / $3,500.00 / $5,634.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.74 / $188.52 / $266.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,646.00 / $24,214.00 / $45,778.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.92 / $184.76 / $263.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.16 / $3,797.33 / $6,036.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.77 / $234.77 / $335.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,834.08 / $15,834.08 / $18,769.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.12 / $304.85 / $304.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.00 / $12,330.00 / $17,416.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.50 / $301.49 / $499.21