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South Dakota rates for HCPCS 64493

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level

Facilitymedian $1,318 · 10th–90th $219$4,2660%20%10th90th$1,318Professionalmedian $251 · 10th–90th $89$1,0000%5%10%10th90th$251$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $1,318.26 / $3,630.78
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$707.95 / $2,884.03 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $190.55 / $1,621.81
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$128.82 / $323.59 / $1,122.02
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $181.97 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $263.03 / $524.81
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $234.42 / $436.52
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,023.29 / $2,511.89 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $371.54 / $3,090.30
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $208.93 / $398.11
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $204.17 / $389.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $245.47 / $346.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $1,659.59
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $223.87 / $467.74
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $213.80 / $416.87