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South Dakota rates for HCPCS 64495

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

Facilitymedian $603 · 10th–90th $50–$2,5700%10%20%10th90th$603Professionalmedian $120 · 10th–90th $51–$3800%10%20%10th90th$120$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
$0.79 / $125.89 / $2,290.87
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,000.00 / $2,570.40 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $93.33 / $218.78
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$141.25 / $295.12 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $147.91 / $269.15
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $120.23 / $199.53
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $186.21 / $2,511.89
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $123.03 / $199.53
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $117.49 / $194.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $173.78
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
$61.66 / $112.20 / $239.88
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $120.23 / $208.93