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Montana 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.28 / $362.28 / $362.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.27 / $246.50 / $513.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.70 / $412.70 / $6,878.02