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Virginia 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
$812.00 / $2,561.00 / $8,920.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49,208.00 / $62,509.00 / $67,760.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.91 / $354.91 / $420.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.20 / $384.26 / $451.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.14 / $408.42 / $611.61
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.39 / $406.45 / $1,595.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,621.00 / $25,197.00 / $46,138.00