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Wisconsin 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
$1,174.90 / $1,174.90 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,905.46 / $2,630.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $15,135.61 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $2,951.21 / $7,244.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $6,165.95 / $9,772.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,162.28 / $3,630.78
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,862.09 / $4,073.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $3,890.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $3,981.07 / $12,302.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,698.24 / $14,454.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $4,677.35 / $6,456.54
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $17,782.79 / $26,302.68
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,762.47 / $8,317.64 / $14,125.38
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $6,309.57 / $6,309.57
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $12,589.25 / $13,489.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $14,454.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,819.70 / $5,754.40