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Hawaii rates for HCPCS 0201T

Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,747.00 / $2,747.00 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.50 / $698.50 / $698.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.25 / $701.25 / $990.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.22 / $1,757.42 / $2,072.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $2,155.00 / $2,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.25 / $2,412.42 / $4,365.57