But it depends on the payer. Some don't cover guidance, some cover it all the time, and some cover it if the patient's BMI is over 35.

To me, it's absolutely worth the minor charge of ultrasound guidance to ensure near 100% accuracy. I can't reference every group and every insurer, but my group charges about $50 for a limited ultrasound and that's about the same overcharge for a guided injection. Many payers cover it, but if they don't you are looking at a total of $150 for 3 injections.