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Pennsylvania rates for HCPCS G0276

Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (PILD) or placebo-control, performed in an approved coverage with evidence development (CED) clinical trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.49 / $2,747.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.97 / $377.97 / $430.02
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.62 / $379.41 / $732.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.90 / $419.90 / $419.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.56 / $325.56 / $325.56
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.51 / $555.61 / $724.60
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $4,761.00 / $8,427.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.85 / $380.00 / $1,976.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.20 / $926.80 / $926.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.90 / $419.90 / $419.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.56 / $325.56 / $325.56
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.49 / $361.49 / $439.68
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.56 / $363.27 / $439.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.62 / $449.50 / $705.07