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Nebraska 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
$1,506.15 / $5,463.36 / $13,841.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,881.23 / $30,095.07 / $58,213.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,884.55 / $14,884.55 / $14,884.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.27 / $499.17 / $15,523.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.00 / $773.18 / $20,419.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,148.00 / $9,696.00 / $15,622.00