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Texas 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
$630.96 / $2,511.89 / $7,585.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $28,840.32 / $56,234.13
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $288.40 / $288.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,498.45 / $19,498.45 / $77,624.71
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $436.52 / $3,162.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $380.19 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $11,481.54 / $58,884.37