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Upper Back Cordotomy, One Side, Single Operation

Wisconsin rates for HCPCS 63195

Surgery for severe pain that has not responded to other treatment. Part of the bony arch of a vertebra in the chest section of the spine is removed to reach the spinal cord, and the pain-carrying pathway is cut on one side of the cord, relieving pain on the opposite side of the body. It is completed in a single operation.

Rates data updated July 2026.

Facilitymedian $4,786 · 10th–90th $3,631$17,7830%20%10th90th$4,786Professionalmedian $5,888 · 10th–90th $2,291$7,7620%20%10th90th$5,888$100.0$500.0$2.0K$10.0K

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

Insurance Carrier
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,630.78
Median
$4,265.80
Typical High
$6,760.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$5,370.32
Typical High
$6,165.95
Medica
Setting
Professional
Modifier
Global
Typical Low
$7,762.47
Median
$7,762.47
Typical High
$7,762.47
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$58.88
Typical High
$70.79
Quartz
Setting
Facility
Modifier
Global
Typical Low
$3,801.89
Median
$5,248.07
Typical High
$5,248.07
Quartz
Setting
Professional
Modifier
Global
Typical Low
$5,888.44
Median
$7,762.47
Typical High
$7,762.47
United
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$17,782.79
Typical High
$20,892.96