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South Dakota rates for HCPCS 63650

Percutaneous implantation of neurostimulator electrode array, epidural

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $1,949.84 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $954.99 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,202.26 / $6,606.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,071.52 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,691.53 / $16,982.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $3,715.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $912.01 / $2,951.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $2,187.76 / $4,265.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $1,288.25 / $4,897.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $977.24 / $5,128.61