CMS Price Transparency Data

Injection procedure for pain management

Facility: Legent Orthopedic + Spine

Billing Code: G0260 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0260
Insurance Median: $695
Cash Discount Price: $1,241
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Injection procedure for pain management at Legent Orthopedic + Spine is $695. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,241. Compared to the federal Medicare reimbursement reference rate of $721.17, this hospital’s rate is 0.96x the Medicare baseline. Located in 5330 North Loop 1604 West, San Antonio, TX.

Cash / Self-Pay

$1,241

Average discount available for prompt cash payment at this facility.

Insurance Median

$695

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$721.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $721.17 (100%)

Cash / Self-Pay: $1,241 (172%)

Insurance Median: $695 (96%)

Cash: $1,241 (172% of Medicare)

Ins. Median: $695 (96% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $721.17 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medicare (plans)	$667	92%
Aetna	$695 - $2,500	96%
Cigna	$695	96%
Humana	$695	96%
Medicaid / KanCare	$695	96%
Blue Cross Blue Shield	$1,048 - $1,313	145%
Tricare	$2,500	347%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,241.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0260.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Legent Orthopedic + Spine is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0260.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.