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South Dakota rates for HCPCS 63688

Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.29 / $359.29 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$414.34 / $607.20 / $969.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$556.02 / $836.97 / $4,569.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.89 / $559.29 / $661.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00