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Maine 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
$660.69 / $1,778.28 / $2,398.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,949.84 / $2,454.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,884.03 / $5,495.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,949.84 / $2,630.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $2,089.30 / $4,466.84