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Virginia 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
$2,187.76 / $4,365.16 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,862.09 / $2,290.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $13,182.57 / $15,488.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,238.72 / $3,981.07
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $8,128.31 / $10,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,332.54 / $9,332.54 / $9,332.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,041.74 / $2,511.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,862.09 / $3,235.94
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,311.31 / $10,964.78
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $3,311.31 / $10,964.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $9,549.93 / $19,054.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $1,737.80 / $4,677.35