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Montana rates for HCPCS 63650

Percutaneous implantation of neurostimulator electrode array, epidural

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $10,000.00 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $1,023.29 / $4,466.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $3,630.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $691.83 / $3,235.94
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $851.14 / $4,073.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $851.14 / $4,073.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $676.08 / $3,311.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $812.83 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,122.02 / $3,388.44