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Washington 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
$565.14 / $2,769.52 / $18,711.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,500.00 / $38,236.33 / $77,786.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.83 / $568.48 / $23,503.87
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.27 / $654.09 / $20,612.12
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.71 / $616.02 / $656.60
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.80 / $433.24 / $22,278.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,032.50 / $38,581.23 / $74,682.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,700.00 / $7,614.00 / $24,236.00