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Wisconsin 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
$281.84 / $645.65 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,481.54 / $17,378.01 / $29,512.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $954.99 / $1,584.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $537.03 / $3,548.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $630.96 / $19,498.45
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $707.95 / $1,071.52
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $38,018.94 / $77,624.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $16,982.44 / $22,387.21