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South Carolina rates for HCPCS L8687

Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,712.61 / $3,712.61 / $3,712.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,712.61 / $3,712.61 / $7,007.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,968.25 / $11,968.25 / $11,968.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,551.49 / $7,551.49 / $7,551.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,418.77 / $7,551.49 / $12,178.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,712.61 / $5,979.44 / $15,522.99
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,491.74 / $14,491.74 / $14,491.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,361.31 / $7,411.94 / $13,938.08