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Indiana 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
$467.74 / $3,801.89 / $5,623.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $39,810.72 / $81,283.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $316.23 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $13,182.57 / $15,848.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $13,803.84 / $20,417.38