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Michigan 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
$390.32 / $2,056.00 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,705.34 / $33,691.62 / $45,646.80
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.35 / $2,056.00 / $4,933.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,000.00 / $12,544.00 / $31,629.00