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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
$2,818.38 / $2,818.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,862.09 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $1,000.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $1,698.24 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,513.56 / $4,365.16