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Ohio rates for HCPCS G0260

Injection Procedure For Sacroiliac Joint; Provision Of Anesthetic Steroid And/Or Other Therapeutic Agent With Or Without Arthrography. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.98 / $1,828.30 / $4,221.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.89 / $127.09 / $260.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.84 / $337.84 / $337.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.00 / $2,012.00 / $3,943.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.95 / $512.25 / $781.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,794.39 / $12,794.39 / $15,902.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.50 / $122.50 / $122.50
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.20 / $1,252.79 / $2,239.33
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.50 / $122.50 / $122.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,940.00 / $4,067.00