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Maine 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
Professional
Modifier
Low / Median / High Price
$133.63 / $254.58 / $289.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.96 / $181.72 / $309.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.62 / $360.54 / $553.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.63 / $254.58 / $289.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.63 / $364.86 / $553.09