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Utah rates for HCPCS 64585

Revision or removal of peripheral neurostimulator electrode array

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $275.42 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $239.88 / $457.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $338.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $6,309.57 / $13,803.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $389.05 / $660.69
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $269.15 / $575.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $346.74 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $223.87 / $407.38