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Pennsylvania 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
$831.76 / $2,691.53 / $8,317.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $537.03 / $537.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,344.23 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $660.69
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $309.03 / $323.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $8,128.31 / $34,673.69