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Maryland rates for HCPCS 64555

Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,064.75 / $2,064.75 / $2,064.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.81 / $507.11 / $2,346.55
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.56 / $304.58 / $341.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $641.21 / $5,526.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.37 / $455.47 / $3,894.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,119.11 / $2,756.70 / $3,969.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,003.00 / $1,003.00 / $2,156.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.90 / $1,734.24 / $3,732.55
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.87 / $2,457.53 / $3,027.30