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Michigan rates for HCPCS 64595

Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.90 / $1,532.65 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,401.83 / $3,992.75 / $5,409.54
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.90 / $1,532.65 / $4,933.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,500.00 / $5,814.00 / $8,738.00