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New Hampshire rates for HCPCS 0201T

Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 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
$660.69 / $1,318.26 / $2,398.83
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
$1,949.84 / $1,949.84 / $1,949.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $5,495.41 / $5,495.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,332.54 / $9,332.54 / $9,332.54
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 / $3,235.94 / $5,011.87
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
$831.76 / $2,951.21 / $5,754.40
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $3,981.07