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Idaho rates for HCPCS 64575

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $4,466.84 / $5,495.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $9,120.11 / $35,481.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,022.64 / $12,022.64 / $12,022.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $478.63 / $933.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,877.62 / $30,902.95 / $42,657.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $12,022.64 / $165,958.69