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Maine rates for HCPCS 27096

Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.90 / $419.19 / $1,713.96
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$274.32 / $527.48 / $1,543.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.23 / $154.41 / $216.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.57 / $110.08 / $157.79
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$140.36 / $165.13 / $236.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.35 / $180.85 / $341.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.05 / $202.80 / $325.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.07 / $528.85 / $1,713.96
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$274.32 / $527.48 / $1,543.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.09 / $155.08 / $239.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.24 / $214.50 / $334.21