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New Hampshire rates for HCPCS 0200T

Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,398.83 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,344.23 / $2,951.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $10,000.00 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $9,120.11 / $9,120.11
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,162.28 / $4,897.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $2,398.83 / $4,786.30
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $3,981.07