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South Dakota rates for HCPCS 64561

Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$9,332.54 / $9,332.54 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $645.65 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$489.78 / $2,344.23 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $891.25 / $2,137.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $977.24 / $2,238.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,659.59 / $8,317.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $707.95 / $1,659.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $676.08 / $1,862.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $1,071.52 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $851.14 / $2,041.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $707.95 / $1,698.24