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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
$1,548.82 / $4,073.80 / $12,589.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,908.68 / $30,199.52 / $58,884.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $501.19 / $18,620.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $741.31 / $1,000.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $10,471.29 / $16,218.10