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South Dakota rates for HCPCS 64494

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)

Facilitymedian $871 · 10th–90th $83–$2,5120%10%10th90th$871Professionalmedian $123 · 10th–90th $51–$3800%10%10th90th$123$1.0$5.0$20.0$100.0$500.0$2.0K

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
$48.98 / $676.08 / $1,258.93
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,071.52 / $2,344.23 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $109.65 / $512.86
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$72.44 / $141.25 / $380.19
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $57.54 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $144.54 / $269.15
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $123.03 / $223.87
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,023.29 / $1,174.90 / $2,511.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $181.97 / $1,819.70
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $123.03 / $199.53
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $114.82 / $190.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $177.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Typical Low / Median / Typical High
$33.11 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $112.20 / $239.88
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $120.23 / $213.80