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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
$299.04 / $299.04 / $2,290.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.84 / $505.38 / $831.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.70 / $773.18 / $23,319.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.73 / $533.78 / $616.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,571.00 / $6,571.00 / $6,571.00