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New Hampshire rates for HCPCS G0276

Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (PILD) or placebo-control, performed in an approved coverage with evidence development (CED) clinical trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $354.76 / $2,331.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.80 / $367.67 / $448.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.90 / $419.90 / $419.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.56 / $325.56 / $325.56
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.11 / $637.32 / $1,250.36
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
$405.11 / $609.87 / $1,286.07
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.70 / $329.67 / $419.58