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Utah rates for HCPCS 63650

Percutaneous implantation of neurostimulator electrode array, epidural

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $5,623.41 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $1,000.00 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $707.95 / $3,715.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,202.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $12,022.64 / $28,183.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,621.81 / $4,365.16
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $2,238.72 / $5,248.07
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $3,162.28 / $4,897.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,128.61 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $912.01 / $2,454.71