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New Hampshire 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
$100.00 / $100.00 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.09 / $289.18 / $320.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,992.79 / $9,992.00 / $19,050.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.96 / $188.98 / $290.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.02 / $283.02 / $283.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.68 / $1,178.68 / $1,178.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.95 / $440.42 / $864.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,399.00 / $12,399.00 / $12,399.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.95 / $443.87 / $781.15
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,306.36 / $5,837.00 / $7,428.90