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South Dakota rates for HCPCS L8687

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,801.04 / $7,801.04 / $7,801.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,491.58 / $7,801.04 / $8,545.57
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
$9,742.50 / $9,839.93 / $12,178.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,742.79 / $14,442.01 / $45,439.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,606.68 / $8,732.10 / $14,043.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,712.01 / $13,975.49 / $19,712.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,406.33 / $14,043.28 / $23,379.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,068.16 / $18,068.16 / $18,068.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,418.23 / $7,411.94 / $10,294.68