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South Dakota rates for HCPCS 64595

Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.09 / $234.95 / $3,167.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.40 / $366.10 / $634.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.22 / $625.52 / $5,822.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.77 / $412.34 / $654.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $6,878.02