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Montana 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
$691.83 / $1,949.84 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,818.38 / $3,162.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,467.37 / $19,952.62
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,467.37 / $19,952.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $1,949.84 / $2,951.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $2,691.53 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $3,235.94 / $3,890.45