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Pennsylvania rates for HCPCS 63650

Percutaneous implantation of neurostimulator electrode array, epidural

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $4,570.88 / $12,302.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $891.25 / $3,162.28
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $524.81 / $2,290.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,125.38 / $14,125.38 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $588.84 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Cigna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $707.95 / $3,630.78
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,981.07 / $4,897.79
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $2,630.27 / $3,801.89
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $13,489.63 / $27,542.29
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $3,801.89 / $12,022.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $1,071.52 / $4,168.69
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $5,128.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $794.33 / $4,570.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $416.87 / $2,187.76
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $416.87 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $5,495.41 / $21,379.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $1,071.52 / $2,818.38