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Indiana 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
$1,380.38 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,513.56 / $2,398.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $30,199.52 / $43,651.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $501.19 / $891.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $26,915.35 / $43,651.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $4,677.35 / $5,623.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $660.69 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $7,762.47 / $10,964.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,621.81 / $3,311.31