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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $125.89 / $2,290.87
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,000.00 / $2,570.40 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $91.20 / $218.78
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$141.25 / $295.12 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $147.91 / $269.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $123.03 / $213.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $173.78 / $2,511.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $123.03 / $199.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $117.49 / $194.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $125.89 / $173.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $117.49 / $239.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $120.23 / $208.93