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Wisconsin rates for HCPCS 63650

Prq Impltj Nstim Electrode Array Epidural

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.29 / $2,174.59 / $8,136.21
Aetna
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$76.45 / $304.50 / $1,627.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.29 / $1,065.74 / $4,005.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,878.00 / $15,141.00 / $22,609.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.41 / $1,173.84 / $2,368.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.58 / $469.90 / $588.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,967.64 / $2,066.02 / $2,652.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,239.35 / $7,291.18 / $11,184.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.86 / $1,960.38 / $10,204.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.29 / $949.18 / $3,327.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.59 / $2,193.10 / $13,721.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,662.03 / $4,054.46 / $16,822.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.15 / $1,686.18 / $4,544.51
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.31 / $949.18 / $3,327.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$951.85 / $2,365.39 / $7,113.92
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,914.92 / $2,914.92 / $10,446.84
Quartz
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$377.84 / $377.84 / $377.84
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.45 / $8,468.69 / $16,822.72
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,486.47 / $2,410.35 / $13,446.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,356.00 / $12,373.00 / $15,090.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,715.50 / $3,576.64 / $8,113.54