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Michigan 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
$414.52 / $2,629.03 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.10 / $430.46 / $3,046.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.52 / $488.52 / $732.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.86 / $339.61 / $828.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.71 / $403.35 / $2,901.39
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.68 / $2,056.00 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.68 / $430.46 / $2,866.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.46 / $1,729.80 / $2,602.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,635.00 / $11,152.00 / $31,629.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.91 / $256.80 / $2,406.30