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Utah 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
$45.89 / $2,922.00 / $5,743.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.89 / $127.09 / $127.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.50 / $122.50 / $122.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $163.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,050.47 / $1,326.87 / $1,910.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.46 / $230.50 / $362.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,106.00 / $1,649.00 / $2,824.00