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Pennsylvania 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
$660.69 / $2,691.53 / $8,317.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $6,165.95 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$77.62 / $77.62 / $77.62
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,952.62 / $19,952.62 / $23,988.33
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $2,089.30 / $7,762.47
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,905.46
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $794.33 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $5,495.41 / $20,417.38