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Utah 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
$407.38 / $3,162.28 / $4,570.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,620.87 / $21,877.62 / $50,118.72
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $512.86 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $5,128.61 / $75,857.76