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Pennsylvania rates for HCPCS 64569

Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $2,747.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.06 / $882.06 / $882.06
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,872.50 / $1,872.50 / $1,872.50
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$934.00 / $3,077.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.06 / $882.06 / $882.06
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.19 / $754.34 / $754.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,468.00 / $4,563.00 / $9,631.00