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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
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.46 / $498.46 / $498.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.17 / $338.48 / $498.46