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South Dakota rates for HCPCS 95977

Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with complex cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.23 / $55.23 / $55.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.87 / $52.17 / $78.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.95 / $101.95 / $127.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.60 / $69.98 / $119.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.31 / $110.93 / $332.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.03 / $120.24 / $132.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.55 / $111.16 / $135.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.61 / $81.94 / $98.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.31 / $92.97 / $112.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.40 / $121.60 / $123.30