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Maryland rates for HCPCS 63650

Percutaneous implantation of neurostimulator electrode array, epidural

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $2,187.76 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $891.25 / $3,630.78
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $457.09 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,348.96 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $812.83 / $3,890.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,884.03 / $4,265.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $1,000.00 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $1,096.48 / $3,019.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $2,951.21 / $3,801.89