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Utah 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
$514.82 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.54 / $390.69 / $1,976.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.56 / $325.56 / $325.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.49 / $323.03 / $398.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,361.94 / $13,564.50 / $19,767.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.44 / $486.18 / $608.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $9,753.00 / $15,824.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.48 / $408.87 / $624.07