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South Dakota rates for HCPCS 64451

Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.73 / $233.55 / $233.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.51 / $195.58 / $233.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.50 / $382.32 / $657.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.70 / $279.68 / $394.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.13 / $455.20 / $1,886.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.55 / $488.51 / $873.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.30 / $385.23 / $575.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.65 / $268.76 / $434.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.75 / $382.97 / $595.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.90 / $193.20 / $527.70