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New Hampshire rates for HCPCS 0630T

Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; each additional level (List separately in addition to code for primary procedure)

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
$76.26 / $86.82 / $96.21
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
$84.96 / $84.96 / $84.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.93 / $353.93 / $353.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.06 / $132.08 / $259.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.39 / $124.95 / $214.56
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00