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South Dakota 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
$1,905.46 / $1,905.46 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,905.46 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,754.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,691.53 / $3,890.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,819.70 / $14,454.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,951.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $2,630.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,862.09 / $5,495.41