go back

Utah 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
$2,951.21 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,454.71 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,454.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $12,302.69 / $28,183.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,905.46 / $2,754.23
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $1,862.09 / $2,041.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,454.71 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $1,258.93 / $2,398.83