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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
$371.54 / $2,630.27 / $8,912.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57,543.99 / $64,565.42 / $70,794.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $363.08 / $426.58
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $489.78 / $776.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $398.11 / $630.96
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $407.38 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $24,547.09 / $48,977.88