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Maryland 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
Professional
Modifier
Low / Median / High Price
$698.50 / $2,162.60 / $2,185.09
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,354.00 / $4,354.00 / $4,354.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.21 / $1,335.00 / $3,314.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,361.55 / $2,361.55 / $2,829.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,939.39 / $2,508.77 / $4,082.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.00 / $643.00 / $2,522.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.39 / $2,320.92 / $4,641.84