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South Carolina 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 (Added 01/28/15)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.47 / $7,799.00 / $21,886.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.42 / $367.54 / $391.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,783.09 / $10,824.58 / $17,240.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.96 / $358.01 / $481.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.90 / $890.00 / $5,740.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.56 / $325.56 / $325.56
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.02 / $390.34 / $809.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,727.33 / $4,727.33 / $4,727.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.71 / $418.00 / $650.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $19,526.00 / $24,161.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.98 / $388.03 / $648.46