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South Dakota 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
$241.19 / $241.19 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.57 / $241.19 / $241.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.92 / $398.87 / $646.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.16 / $510.94 / $1,840.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.69 / $455.67 / $28,474.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.69 / $371.35 / $455.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.54 / $461.14 / $717.33