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Tennessee 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
$127.09 / $1,502.40 / $4,069.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.89 / $127.09 / $127.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$764.00 / $1,487.00 / $2,244.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.05 / $165.06 / $290.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.50 / $122.50 / $122.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,061.88 / $2,061.88 / $2,144.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.00 / $1,560.00 / $2,914.00