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Montana 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
$271.33 / $290.72 / $290.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.50 / $397.50 / $397.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.88 / $357.75 / $397.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.41 / $160.41 / $397.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.88 / $397.50 / $559.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.32 / $438.48 / $498.96