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Montana 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
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,187.76 / $2,951.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,754.23 / $3,090.30
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,388.44 / $19,952.62
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,388.44 / $19,952.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $2,041.74 / $3,090.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,754.23 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $2,290.87 / $2,818.38