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South Dakota rates for HCPCS 64581

Open implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$631.75 / $631.75 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.02 / $1,092.34 / $1,774.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.00 / $1,732.26 / $12,864.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.21 / $1,106.44 / $1,275.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,000.00 / $6,000.00 / $6,000.00