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Utah rates for HCPCS G0259

Injection procedure for sacroiliac joint; arthrography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $125.89 / $138.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $141.25 / $257.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61