go back

Montana rates for HCPCS 64575

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

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $549.54 / $691.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $416.87 / $602.56