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Selective Stomach Nerve Cutting For Ulcers

Pennsylvania rates for HCPCS 64755

An operation that divides the small nerve branches supplying the acid-producing upper part of the stomach, so the stomach makes less acid and ulcers can heal. The branches serving the rest of the stomach are deliberately left intact so that the stomach still empties normally.

Facilitymedian $5,370 · 10th–90th $955$8,5110%10%20%10th90th$5,370Professionalmedian $955 · 10th–90th $794$1,6220%50%10th90th$955$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$5,754.40
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$933.25
Typical High
$1,513.56
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$20,417.38
Median
$21,379.62
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,412.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,096.48
Typical High
$1,819.70
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,380.38
Typical High
$1,778.28
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,096.48
Typical High
$1,548.82
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$3,981.07
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$933.25
Typical High
$1,445.44
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,380.38
Typical High
$1,949.84
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$1,047.13
Typical High
$1,905.46
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$1,047.13
Typical High
$1,905.46
United
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$2,630.27
Typical High
$7,079.46
United
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,071.52
Typical High
$1,819.70