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New Hampshire 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
$1,819.70 / $2,398.83 / $9,772.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $10,471.29 / $19,952.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,073.80
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,122.02