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Wisconsin rates for HCPCS 63650

Percutaneous implantation of neurostimulator electrode array, epidural

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,570.88 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $1,096.48 / $4,570.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,022.64 / $16,982.44 / $28,840.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,071.52 / $2,344.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $7,244.36 / $11,748.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,862.09 / $10,471.29
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $2,238.72 / $4,365.16
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,445.44 / $5,888.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $2,398.83 / $14,125.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $3,388.44 / $16,982.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $2,630.27 / $7,762.47
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,498.45 / $28,840.32 / $28,840.32
Quartz
Facility/Professional
Facility
Modifier
53
Low / Median / High Price
$3,890.45 / $3,890.45 / $5,754.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $9,332.54 / $15,848.93
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,691.53 / $13,489.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $13,803.84 / $17,378.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $1,659.59 / $5,623.41