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Maryland 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
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $338.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $346.74 / $602.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $2,187.76 / $4,073.80