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Montana rates for HCPCS 64555

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.09 / $1,027.33 / $3,502.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.97 / $508.97 / $3,347.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.97 / $508.97 / $508.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.97 / $350.95 / $3,012.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.83 / $304.56 / $1,987.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.00 / $863.46 / $4,234.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.52 / $2,875.51 / $3,514.49