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Maryland rates for HCPCS 63663

Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,000.00 / $4,897.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,148.15 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,000.00 / $2,137.96