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South Dakota rates for HCPCS 64575

Open implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $2,290.87 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $512.86 / $831.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $741.31 / $741.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $524.81 / $616.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93