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Steroid Injection

Do you need an injection? This package includes a limited office visit with a physician or one of our highly trained advanced practice providers, and a steroid injection in the joint or soft tissue without image guidance. PURCHASE THIS PACKAGE ONLY IF A HEALTHCARE PROVIDER IN OUR PRACTICE HAS ORDERED IT FOR YOU. The injection is for only one joint or body area and the office visit is limited to providing the injection only.*This does not include any type of imaging or radiographic guidance.

$130.00

Patient Name

DOB (mm/dd/yyyy)

Direct Pay Service

I acknowledge this direct pay service will not be filed with my insurance and cannot be filed at a later date.

Refund

I will not be refunded if services are rendered. However, I acknowledge I will be refunded if my provider does not agree with the plan of care and services are not rendered.

Business Day Delay

If payment made after hours, on the weekend or holiday, your payment may not be posted to your account until the next business day. Please show your emailed receipt at your upcoming appointment.