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Pennsylvania 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
Facility
Modifier
Low / Median / High Price
$1,047.13 / $5,754.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,905.46 / $2,951.21
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,778.28 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,454.71 / $9,120.11
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,691.53 / $3,981.07
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $831.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,265.80 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,862.09 / $2,951.21
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $457.09 / $1,737.80
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $457.09 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,981.07 / $22,387.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $1,698.24 / $3,162.28