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South Dakota rates for HCPCS 64495

Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 3+ Level

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.34 / $91.14 / $1,030.61
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,004.86 / $1,132.06 / $2,554.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.64 / $85.93 / $146.50
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$141.33 / $142.82 / $380.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.78 / $146.44 / $260.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.34 / $120.55 / $211.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.57 / $201.70 / $2,504.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.35 / $158.51 / $237.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.00 / $139.35 / $228.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.13 / $125.15 / $174.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.57 / $160.65 / $249.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.20 / $120.10 / $211.20