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Montana rates for HCPCS 63663

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

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,318.26 / $1,621.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $891.25 / $1,548.82