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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
$641.00 / $2,326.00 / $7,629.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.91 / $354.91 / $354.91
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,950.90 / $13,950.90 / $13,950.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $2,326.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.91 / $354.91 / $354.91
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.97 / $298.97 / $326.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,340.00 / $6,515.00 / $12,076.00